Common Femoral Artery Stenting: Computed Tomography Angiography Based Long-Term Patency

Abstract

Background: Despite considerable morbid-mortality rates, common femoral endarterectomy is still considered the gold standard for atherosclerotic common femoral artery (CFA) disease. The aim of this study was to demonstrate computed tomography angiography based long-term patency after CFA stent placement and to analyze associated risk factors for restenosis. Methods: A retrospective and observational study was carried out in consecutive patients treated with endovascular stent placement in CFA lesions. A clinical follow-up and imaging study was performed using MD-CTA to assess different degrees of in stent restenosis (ISR) and primary, assisted, and secondary patency rates. Results: In a 5-year period, 35 extremities were treated in 33 patients with self-expandable nitinol stents. The technical success was 100% without complications related to the procedure. The mean follow-up (FU) was 32.2 months, and 8 limbs were lost. The degree of CFA stenosis was reduced from 79.69 ± 26.47% to 11.23 ± 24.53%. ISR < 20%, 20–70%, and ≥ 70% was evident in 15 (55.6%), 9 (33.3%), and 3 (11.1%) limbs, respectively. Estimated primary, assisted, and secondary patency was 79.5, 96.3, and 96.3%, respectively, after 24 months and 79.5, 96.3, and 96.3%, respectively after 60 months, with a freedom of clinical driven target lesion revascularisation rate of 87.8%. Conclusion: Endovascular treatment with self-expandable nitinol stents in CFA lesions had a high technical success rate and was related to few complications. A mild form of intimal hyperplasia was observed in a considerable number of cases. However, long-term patency was high; therefore, CFA stent placement might be a suitable therapeutic alternative in selected patients.

Surgical, Endovascular, and Multimodal Approaches to the Management of Atherosclerotic Common Femoral Artery Disease

“…[19][20][21] Long-term outcomes, out to 5 years, demonstrate while primary patency rates are lower, primary assisted and secondary patency rates >95% can be achieved. 18,22 As noted in the previous section, limited luminal gain and residual stenosis is a major threat to long-term patency after endovascular intervention. Primary stenting provides an immediate benefit as it addresses the residual stenosis often seen after angioplasty.…”

“…23 Mid-term data show nearly a third of patients will develop moderate (20-70%) in-stent stenosis as a result of neointimal hyperplasia while significantly less demonstrate severe (>70%) restenosis. 22,24 The clinical effect of in-stent stenosis is variable depending on the residual lumen diameter and the presence or absence of inflow/outflow disease.…”

Percutaneous Endovascular Reconstruction of the Common Femoral Artery and Its Bifurcation

“…One of the main issues is the high level of nodular calcification, which is often accompanied by osteoid metaplasia. This can limit lumen gain, which makes vessel preparation a necessity [ 14 , 15 ]. In advanced disease affecting the bifurcation, the challenge is reflected by the aim of preserving both the superficial (SFA) and the deep femoral arteries (DFA).…”