Disobliteration Techniques

  • Gwan H. Ho
  • Frans L. Moll


Endovascular surgical procedures have become an integral part of the treatment of arterial occlusive disease in the femoropopliteal segment—an adjunct to conventional peripheral arterial reconstructions.1–3 Additionally, new percutaneous arterial disobliteration devices have been designed. Catheter-based therapies such as percutaneous transluminal balloon angioplasty (PTA) have been effective for short and solitary lesions in the femoropopliteal segment. However, the long-term patency results of PTA or laser-assisted balloon angioplasty are discouraging for long (more than 10 cm) occlusive lesions.4–7 The use of stents in the femoropopliteal artery in combination with angioplasty has not truly altered these results despite close surveillance and reintervention.8–10 Alternative techniques to recanalize chronic occlusions of the superficial femoral artery are based on plaque removal rather than stretching and remodeling the arterial wall. These methods can be divided into two categories: “going through” and “going around” the occlusion. Common to both methods is the ability to remove the occlusive atheroma using a mechanical atherectomy device or performing endarterectomy. Atherectomy devices were developed to improve the results of lesions that were unfavorable for PTA and to decrease the incidence of acute arterial thrombosis. Transluminal endarterectomy has a history of more than 50 years, the first case being reported in 1947 by the Portugese surgeon J. Cid Dos Santos.11,12 Also, endarterectomy has shown far better long-term patency results than PTA for long lesions because of a high incidence of recurrent stenoses after balloon angioplasty that require repeated intervention.13


Balloon Angioplasty Popliteal Artery Superficial Femoral Artery Venous Bypass Femoropopliteal Artery 
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© Springer Science+Business Media New York 1999

Authors and Affiliations

  • Gwan H. Ho
  • Frans L. Moll

There are no affiliations available

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