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Outcomes with and without Femoral Endarterectomy in Lower Extremity Bypass
Peter A. Soden, MD, Sara L. Zettervall, MD, Dominique B. Buck, MD, John C. McCallum, MD, Jeremy D. Darling, BA, Marc L. Schermerhorn, MD.
Beth Israel Deaconess Medical Center, Boston, MA, USA.

OBJECTIVES:
Femoral endarterectomy (FEA) is often used in conjunction with lower extremity bypass. There is limited literature addressing complications related to FEA. This study will look at complication rates of FEA in lower extremity bypass (LEB) patients.
METHODS:
All patients undergoing non-emergent LEB in the Vascular Targeted NSQIP database from 2011-2012 were identified. Patients were divided into LEB alone and LEB with FEA. These groups were further divided into claudication and critical limb ischemia (CLI). Chi-square, t-test, and multivariable logistic regression were used to compare pre-op characteristics and outcomes, including SSI, bleeding, return to OR, and death.
RESULTS:
Out of the 2621 patients undergoing LEB 356 underwent concomitant FEA (29.5% for claudication and 69.5% for CLI). (Table) Pre-operatively in the claudication group, LEB with FEA patients had a higher rate of COPD compared to LEB alone (22.9% vs 11.9%, p = 0.00) but were otherwise similar. Age (Table) and Race (LEB w FEA: 79.3% white vs LEB alone: 71.1%, p = 0.01) were the only differences within the CLI group. There was no difference in proportion of patients with tissue loss (58.6% vs 59%, p = 0.95) and rest pain in LEB versus LEB w FEA respectively. Operative time was increased when FEA was added to a LEB in both claudicants (235 vs 191 min) and patients with CLI (260 vs 222 min). In claudicants, bleeding, defined as any transfusion or return to OR for bleeding, was higher in LEB with FEA (18.1% vs 8.0%, p = 0.00) but not for CLI (21.5% vs 19.1%, p = 0.39). All other outcomes (including wound infection, myocardial infarction, amputation, LOS, and readmission), were similar between LEB and LEB with FEA.
CONCLUSIONS:
FEA in LEB, whether for claudication or CLI, adds operative time. FEA also increases bleeding in claudicants. Despite increased operative time and possibly bleeding there is no difference in length of stay, readmissions, wound complications, or death when FEA is added to LEB. The addition of FEA does not substantially increase the morbidity and mortality of LEB bypass.
Comparison of LEB with and without FEA in Claudicant and CLI groups
Claudication,
LEB only (N=739)
Claudication,
LEB with FEA (N=105)
OR (95% CI) or P-valueCLI,
LEB only (N=1526)
CLI,
LEB with FEA (N=251)
OR (95% CI) or P-value
Age (years, mean)67.566.9p = 0.1568.269.6p = 0.01
Obesity (BMI > 30)33.1%27.6%0.77(0.49-1.2)29.5%23.8%0.75(0.55-1.0)
OR time (min, median w quartiles)191(141-251)235(178-327)p = 0.00222(168-296)260(193-327)p = 0.00
Death0.5%0.0%1.0(0.99-1.0)2.8%2.8%1.0(0.45-2.3)
Bleeding8.0%18.1%2.6(1.5-4.5)19.1%21.5%1.2(0.84-1.6)
SSI7.0%6.7%0.94(0.42-2.1)9.2%11.2%1.2(0.8-1.9)
Return to OR7.8%4.8%0.59(0.23-1.5)19.3%21.1%1.1(0.8-1.6)
Re-admission in 30 days2.7%0.0%0.97(0.96-1.0)5.2%4.4%0.83(0.44-1.6)
Length of stay (days, median w quartiles)3(2-5)4(3-6)p = 0.187(4-13)7(4-12)p = 0.90


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