How to Avoid a Difficult Groin in Redo Arterial Surgery: Eversion Endarterectomy of the Proximal Superficial Femoral Artery Versus Profunda Femoris Artery as Inflow for Distal Bypass

Background: The aim of the study was to describe and analyze the results of a technique in which the inflow for distal bypasses is provided by the proximal superficial femoral artery, reopened through an eversion endarterectomy, to avoid a "difficult groin." Material and Methods: Twenty-one patients who underwent distal bypass for severe lower-limb ischemia and in whom the proximal superficial femoral artery was reopened with an eversion endarterectomy to provide inflow for the bypass itself were included in the study. As a comparison group, 20 patients in whom the inflow for a distal bypass was obtained by the distal deep femoral artery were randomly selected. In all 41 patients, the groin was considered "difficult" because of multiple previous operations. Results: Five-year cumulative patency rates were 53% for femoropopliteal bypasses and 40% for femorotibial bypasses. Similar patency rates were obtained when the distal deep femoral artery was used as inflow. Conclusions: Eversion endarterectomy of the proximal superficial femoral artery provides a valid source of inflow for distal bypasses, and it should be kept in the armamentarium of the vascular surgeon, to be used in selected cases.