[Severe ischemia caused by femoro-popliteal thrombosis. Endarterectomy using a pneumatic oscillator].

Autologous saphenous vein bypass is the best treatment for severe ischemia with femoro-popliteal thrombosis. But in over 20% of cases a vein is not available. Patency rates after prosthetic grafts are low. Therefore we have tested femoro-popliteal endarterectomy with the Hall arterial oscillator. This instrument is composed of loops (size: 5-12 mm) and of a pneumatic oscillator. All the length of the artery has to be exposed. The endarterectomy is started with a spatula and is then performed with the oscillating loops. Three arteriotomies are usually necessary to remove the total core. After the arterial vacuity has been checked, the distal intima is tacked down and the arteriotomies are closed with or without a venous patch angioplasty. Thirteen patients have been operated on. All of them were high risk patients. They were submitted to surgery for rest pain, distal gangrene or acute ischemia. During the post-operative period, one death and 4 thromboses occurred, the latter leading to major amputation with two subsequent deaths. Early results of the 8 other patients were good. Mean follow-up was ten months. Limb salvage was achieved in 7 patients out of 8,6 of them with patent artery and 1 with an occluded artery. Run off was an essential condition for patency. The best results were achieved when distal arteries were patent. But some success occurred in spite of a poor run off. This technic is an useful and money saving alternative for severe ischemia associated with femoro-popliteal thrombosis when autologous vein is not available.