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INTRODUCTION
Endovascular treatment of the common femoral artery (CFA) can present a challenge when considering its unique anatomy and biomechanical characteristics. Not all patients are candidates for open revascularization. Limited and conflicting data exist as to whether stent placement in the common femoral artery can be performed with acceptable patency rates and low complication rates.
METHODS
Over a 5-year period ending July, 2015, 1,592 stents were placed in 652 patients during lower extremity endovascular interventions performed by a single group of vascular surgeons. Of these, 40 stents were used to re-vascularize the CFA in 36 patients. A prospectively-collected database was retrospectively analyzed for clinical outcomes, including indication, technical success, patency, complications, and limb salvage.
RESULTS
Technical success was achieved in 100% of stent placements. Indications for stent placement included stenosis (18; 47%), dissection (17; 45%), and thrombosis or pseudoaneurysm at prior access site (5; 13%). Average follow-up in this patient population was 18.1 months (1.1-66). Thirty-three (84%) CFA stents remained primarily patent and two secondarily patent throughout the follow-up period. Overall, limb salvage rates during the follow up period was 81%. Re-intervention occurred at an average of 10 months (.1-33 mo) post-op. One stent (2.5%) became kinked, requiring re-stenting within 30 days post-placement. Three major (AKA/ BKA) and 3 minor amputations occurred on treated limbs within the follow-up period. Regarding major amputations, the CFA stent was found to be occluded (1 year post placement), patent and uninvolved (18 months post placement); and complicated (7 weeks post placement) by MRSA regional necrosis from an infected pseudoaneurysm at the previous access site. One patient died within 60 days post-op of MRSA pneumonia/sepsis, however ultrasound imaging 10 days prior to death confirmed stent patency, and Rutherford 5 pre-op wounds had resolved. No stent fractures were noted after CFA stent placement.
CONCLUSION
Despite conflicting evidence in the literature to date, our study suggests common femoral artery stent placement is a viable revascularization option with acceptable patency rates, high limb salvage rates, and low complication rates.