Long-Term Outcomes following Common Femoral Endarterectomy

Abstract

Thromboendarterectomy of the common femoral artery (CFA) for occlusive disease is a crucial procedure in vascular surgery. As an outcome reference for emerging endovascular procedures and new devices, we need more robust evidence of the outcome of this gold standard technique. The purpose of this study was to report 10-year results after femoral endarterectomy (FEA). A retrospective review of medical records at our institution identified eighty consecutive patients (91 limbs) who underwent FEA for CFA lesions. Indications for FEA included 50 limbs (55%) for intermittent claudication (IC) and 39 limbs (43%) with chronic limb-threatening ischemia (CLTI). Two limbs (2%) underwent FEA to prevent hemodynamic steal during extra-anatomical bypass. Adjunctive procedures included endovascular therapy in 32%. CFAs were closed with patch angioplasty in 44%. With a mean follow-up period of 39 months, the survival rates at 3 and 8 years were 85% and 77%, respectively. Limb salvage rates were 92% and 87%. Primary patencies were 98% and 84%. Freedom from target lesion revascularization was 95% at 3 years and 91% at 8 years. Our findings support the durability of FEA, with comparable long-term procedural results in CLTI patients as well as IC patients. Since the FEA is a gate maneuver for hybrid revascularization in CLTI patients, our findings support a strategy combining open and endovascular approaches. Femoral endarterectomy remains a durable solution for common femoral occlusive disease in IC and CLTI in the era of endovascular therapy.

Unusual approach to popliteal vein bypass graft stenosis following failed angioplasty in popliteal entrapment syndrome

“…For this patient, it was felt to be appropriate given the unusual circumstances. Several studies demonstrate good long-term outcomes for femoral/popliteal endarterectomy, a common vascular procedure used for patients with claudication and critical limb ischaemia 2–4. Hashimoto et al demonstrated that at 5, 10 and 15 years following isolated endarterectomy, no further revascularisation procedures on the side initially operated on were required in 68%, 50.6% and 42.5% of cases, respectively 3.…”

“…Several studies demonstrate good long-term outcomes for femoral/popliteal endarterectomy, a common vascular procedure used for patients with claudication and critical limb ischaemia 2–4. Hashimoto et al demonstrated that at 5, 10 and 15 years following isolated endarterectomy, no further revascularisation procedures on the side initially operated on were required in 68%, 50.6% and 42.5% of cases, respectively 3. Thus, endarterectomy has been seen to be a beneficial procedure which has a high success in a range of patients, so the use of graft endarterectomy in selected vascular patients may prove useful.…”

Percutaneous Endovascular Reconstruction of the Common Femoral Artery and Its Bifurcation

“…Upon closer inspection, OSR may not be as innocuous as originally believed, with postoperative complications delineated in up to one-quarter of treated patients. Research has been limited to registries and a small number of trials, which have not indicated a decrease in periprocedural complication rates over the past decades [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. The most frequent complications are still related to the incision site and include wound complications owing to infection, dehiscence, lymphatic leakages, haematoma, and neural dysaesthesia [ 9 , 12 , 13 ].…”

Zur operativen Therapie der peripheren arteriellen Verschlusskrankheit

“…1) [1]. Die langfristigen Offenheitsraten für solche lokalen Rekonstruktionen sind mit einer Offenheitsrate von 98 % nach 3 Jahren sehr gut [2,3]. Bei vorliegendem kollateralisiertem Verschluss der A. femoralis superficialis, in Kombination mit einer relevanten Abgangsstenose der A. profunda femoris, kann schon die alleinige Rekonstruktion der Femoralisgabel unter Einbeziehung des proximalen Anteils der A. profunda femoris durch eine sog.…”