Eversion Femoral Endarterectomy for Iliofemoral Occlusive Disease: A Description of Technique and Series of Cases

Background Eversion endarterectomy (EE) is a well-described technique for the treatment of extracranial cerebrovascular disease. Longitudinal arteriotomy and closure with patch angioplasty is the standard for infrainguinal arterial occlusive disease in the iliofemoral segment. A potential drawback of this technique is the introduction of exogenous material into the field. We herein describe a technique of transverse femoral arteriotomy with primary closure for treatment of chronic limb ischemia involving the iliofemoral system. Methods We retrospectively evaluated all patients who underwent EE at our institution for chronic limb ischemia. Eleven patients were identified who underwent EE by a single surgeon (M.N.) at our institution from 2013 to 2014. Indications for operation included life-limiting claudication, rest pain, and tissue loss. In each case, the external iliac artery (EIA), common femoral artery (CFA), or superficial femoral artery (SFA) was divided with eversion of the proximal and distal segments and endarterectomy. Reconstruction was achieved with primary end-to-end closure. Preoperative demographics were evaluated, as well as preoperative and postoperative ankle-brachial indices and Trans-Atlantic Inter-Society Consensus (TASC) II lesion classification when available. In addition, all adjunctive procedures performed both at the time of index operation and subsequently were recorded. Clinical improvement was gauged using the recommended scale for gauging change in clinical status according to Rutherford. Results Follow-up ranged from 6 weeks to 16 months. There were no amputations, deaths, or surgical site infections. Two patients required concomitant patch angioplasty in the treated segment at the index operation. There was symptom improvement in 9 of 11 patients, with 2 requiring reintervention due to poor outflow. Conclusions In patients with arterial occlusive disease of the iliofemoral segment, EE either alone or in association with endovascular stenting or open bypass appears to be a safe and effective technique. It may obviate the need for patch closure. In our initial case series, there were no amputations, deaths, or surgical site infections. Symptoms improved in 9 of 11 patients with only 2 requiring reintervention due to recurrent symptoms during the follow-up period.