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OBJECTIVES: Traditionally patients with iliofemoral arterial occlusive disease have been treated with open surgical repair, specifically aorto-femoral or ilio-femoral bypass. More recently the hybrid procedure of combining femoral endarterectomy with open iliac artery stenting (FEIS) has been used, but long term results have not been widely reported.
METHODS: This is a retrospective cohort study of patients undergoing FEIS at a tertiary heath center stratified according to the severity of the arterial occlusive disease as described by the Trans-Atlantic Inter-Society Consensus (TASC) into patients with mild disease (TASC A/B) and severe disease (TASC C/D). Primary patency, limb salvage, and survival were compared.
RESULTS: Between January 1, 2004 and December 31, 2013, there were 111 patients (34 TASC A/B and 77 TASC C/D) that underwent FEIS. Indications for surgery were claudication (41%), ischemic rest pain (36%), and tissue loss (23%). 30 day perioperative death rate was 0% in TASC A/B and 9.1% in TASC C/D (p=0.098). Median length of follow up was 17 months (range 0 months - 90 months). Primary patency & limb salvage were not significantly different at long-term follow up and was 78.5%/91.2% in TASC A/B patients and 80.7%/96.1% in TASC C/D patients (p=0.6367 for patency and p=0.5127 for limb salvage). TASC C/D patients had higher long term mortality (p=0.0413). Univariate analysis did not identify any device related or anatomic factors predictive of stent patency (balloon expandable stent vs self-expanding stent, p=0.5639; covered stent vs non-covered stent, p=0.9999; stent diameter, p=0.1731; stent length, p=0.7751; or location of stent in common iliac artery vs external iliac artery vs both, p= 0.1086).
CONCLUSIONS: Patency rates and limb salvage rates are similar for TASC A/B patients and TASC C/D patients after the hybrid procedure of femoral endarterectomy and iliac stenting and should be considered as an alternative for standard aortic based surgery in selected patients.