Catheter-based therapy of common femoral artery atherosclerotic disease

Abstract

The objective of this paper is to describe outcomes of endovascular therapy in patients with symptomatic common femoral artery (CFA) lesions. Symptomatic atherosclerotic disease of the common femoral artery is an uncommon clinical entity, and there is no consensus regarding the suitability of catheter-based therapy. We reviewed the records of 26 consecutive patients treated with catheter-based therapy for symptomatic CFA lesions between 1994 and 2009. Angiographic success and procedure success were obtained in all vessels and in all patients. At 1 year, 100% (16/16) of the claudication patients and 70% (7/10) of the critical limb ischemia (CLI) patients maintained clinical success. The anklebrachial index (ABI) significantly improved from a baseline of 0.47 ± 0.18 to 0.77 ± 0.18 (p < 0.001) after the procedure. At their most recent clinic visit (31 months ± 14 months), clinical success was maintained in 100% of the claudication patients and in 70% (7/10) of the CLI patients. During the follow-up period, femoral vascular access for an unrelated procedure was obtained through the CFA stent. In conclusion, patients with symptomatic CFA atherosclerotic disease obtained excellent clinical outcomes with angioplasty with stenting. We found that angioplasty with stenting of the CFA did not preclude future CFA vascular access. Our data suggest that catheter-based therapies should be considered as an option to open surgery in selected patients with symptomatic CFA disease.

Systematic review of endovascular intervention and surgery for common femoral artery atherosclerotic disease

“…Acknowledging this limitation, overall the endovascular group had a higher risk of needing further revascularization at 1 year (16·0 (95 per cent c.i. 6·1 to 29·4) per cent; 4 studies, 167 procedures) in comparison with the CFE group (5·8 (1·0 to 14·2) per cent; 6 studies, 489 procedures). Results after 1 year were similar ( Table ).…”

“…The cumulative event rate was lower in the endovascular group than that in the CFE group: 75·7 (95 per cent c.i. 64·6 to 85·2) per cent (5 studies; 224 procedures) versus 90·0 (82·9 to 95·1) per cent (6 studies; 369 procedures) ( Fig. S2 , supporting information).…”

“…A similar trend was seen for the longer‐term primary patency rate ( Table ). The length of follow‐up for the four case series in the endovascular group was 18, 24 and 60 months (two studies), and that for the eight case series in the CFE group was 17, 24 (three studies), 31, 36, 60 and 84 months ( Table ).…”

Assessing the Perioperative Safety of Common Femoral Endarterectomy in the Endovascular Era

“…Results are comparable to largest reported endovascular CFA series' postoperative outcomes that had 1.2% in-hospital mortality, 1.4% postprocedure myocardial infarction, and an overall 6.4% periprocedural complications. 14 Only patients with functional dependence and dyspnea at rest were at significantly higher risk of 30-day mortality. It is not surprising that functional dependence is a predictor of poor outcomes in CFE as it a known predictor of morbidity and mortality in lower extremity bypass.…”

Management of common femoral artery occlusive disease: A review of endovascular treatment strategies and outcomes

“…Thiney et al reported a single center study, 2‐year primary patency rate of 92.5%, and Nasr et al described the 5‐year primary patency to be 72.5%. Paris et al demonstrated a primary patency rate of 92.3% at 1‐year in 26 CFA lesions treated with PTA, which all required provisional stenting. de Blic et al evaluated 35 CFA lesions and demonstrated that 66% required provisional stenting, with a 1‐year primary patency of 88.6% in these subjects.…”