Femoral bifurcation disease: Balloon or knife

Abstract

Arterial occlusive disease at the level of the femoral bifurcation mostly occurs in combination with inflow and/or outflow lesions. Surgical endarterectomy of the femoral bifurcation is a well-proven low-risk and easy surgical intervention with known durable success, while, although proven to be safe, evidence is lacking about the durability of the endovascular approach. Based on the evidence at hand, the surgical approach should be recommended for the vast majority of patients and the endovascular approach should only be indicated as the first strategy in selected cases presenting with factors that might compromise the outcome of surgery in the groin. If feasible, the hybrid approach with endarterectomy at the level of the bifurcation and endovascular repair of the inflow and outflow lesions is preferred in patients with multilevel disease.

Endovascular treatment of common femoral artery obstructions

“…[1][2][3][4][5][6] Associated primary patency rates are reported to be as high as 96% up to 7 years; 4 however, major complications such as infections, hematoma, seroma, and lymphatic leaks may occur in up to 17.1% 7 of cases.…”

Combined Direct Repair and Inline Inflow Stenting in the Management of Aortoiliac Disease Extending Into the Common Femoral Artery

“…32 Device atherectomy of the CFA segment has also been described, 33 although reliable reports with adequate follow-up have so far been lacking and several studies continue to document the superiority of the endarterectomypatching approach for CFA disease. 34,35 Hybrid approaches combining open repair of the femoral occlusive disease with stenting of the contiguous upstream iliac pathology have been sporadically described and offer a lesser invasive alternative in those instances. 22,36 Our group adopted a view that a hybrid approach combining direct repair of the CFA disease with inline endovascular stenting of the iliac disease could be advantageous by allowing a lesser invasive management of this difficult disease pattern.…”

Tunneled Ipsilateral Sheath: A Novel Technique in Endovascular Management of Superficial Femoral Artery Ostial Lesions

“…The former is difficult in the presence of iliac artery excess tortuosity, occlusion, or stent. 2 With brachial access, simultaneous management of infragenicular lesions may be difficult. 3 Operators who adopt the antegrade ipsilateral approach in the presence SFA ostial lesions generally insert only the distal few centimeters of the sheath into the CFA.…”