Superficial Femoral Artery Remote Endarterectomy: A Systematic Review and Meta-Analysis

Background: Remote superficial femoral artery endarterectomy (RSFAE) is a hybrid procedure with low risk for perioperative complications and promising patency rates over time. The aim of this study was to summarize current literature and to determine the role of RSFAE in limb salvage with regards to technical success, limitations, patency rates and long-term outcomes.Methods: This systematic review and meta-analysis was performed according to the preferred reporting items for systematic reviews and meta-analyses guidelines.Results: Overall 19 studies were identified, comprising 1,200 patients with extensive femoropo-pliteal disease among whom 40% presented with chronic limb threatening ischemia. The average technical success rate was 96%, with a 7% rate for perioperative distal embolization and 13% rate for superficial femoral artery perforation. The primary patency was 64% and 56%, primary assisted patency was 82% and 77%, and secondary patency was 89% and 72% at 12 and 24 months follow-up, respectively.Conclusions: For long femoropopliteal TransAtlantic InterSociety ConsensusC/D lesions, RSFAE appears to be a minimally invasive hybrid procedure with acceptable perioperative morbidity, low mortality, and acceptable patency rates. RSFAE should be considered an alter-native to open surgery or a bridge to bypass.