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Contemporary Outcomes Of Common Femoral Endarterectomy
Armin Tabiei, M.D., Venkata Vineeth Vaddavalli, M.B.B.S., Jesse Chait, D.O., Manju Kalra, M.B.B.S., Thomas C. Bower, M.D., Randall R. DeMartino, M.D., M.S., Melinda S. Schaller, M.D., Bernardo C. Mendes, M.D., Todd E. Rasmussen, M.D., Jill J. Colglazier, M.D., Fahad Shuja, M.B.B.S..
Mayo Clinic, Rochester, MN, USA.
OBJECTIVES: Previously published registry data has cited high morbidity and mortality associated with common femoral endarterectomy (CFE), lending support to endovascular therapies. Our aim was to analyze patient data and study contemporary outcomes of CFE at an academic hospital.
METHODS: This is a retrospective review of all consecutive patients undergoing CFE for atherosclerotic disease at our institution over a 5-year period (2018-2023). Patients undergoing redo endarterectomy, CFE for acute limb ischemia, concomitant bypass or to facilitate large bore arterial access were excluded. Patient co-morbidities, imaging, 30-day morbidity and mortality, long-term primary patency, freedom from major amputation and overall survival were assessed.
RESULTS: There were 272 patients (320 limbs) with a mean age of 72 ± 11 years. 197 patients (72%) were men. Indication for treatment was CLTI in 151 limbs (47%). The ipsilateral superficial femoral artery was patent (<50% stenosis) in 48 limbs (15%), diseased (50-99% stenosis) in 139 limbs (43%) and occluded in 133 limbs (42%). Bovine pericardial patch angioplasty was performed in 318 limbs (99%). Retrograde concomitant ipsilateral iliac artery stenting was employed in 165 limbs (52%). Concomitant ipsilateral distal endovascular intervention was performed in 50 limbs (16%). Median length of stay was 3 days (interquartile range, 2-5 days). Two patients died within 30 days (0.74%) and eight (2.9%) suffered a myocardial infarction. Local wound complications (infection, lymphocele and seroma) occurred in 30 limbs (9.4%), of which 19 (5.9%) required operative re-intervention (Figure 1). Higher BMI was associated with significantly increased risk of surgical site infection on Cox proportional hazard model (p=0.04). Median follow-up was 18.5 months (interquartile range, 8-34 months). Mean pre-operative and follow-up ankle-brachial indices were 0.49 ± 0.20 and 0.74 ± 0.24, respectively. Primary patency rates at 1, 3 and 5-years were 97%, 91% and 89%, respectively. Freedom from major amputation rates at 1, 3 and 5-years were 93%, 92% and 89%, respectively. Survival rates at 1, 3 and 5 years were 91%, 69% and 50%, respectively.
CONCLUSIONS: Common femoral endarterectomy remains a safe and durable treatment for femoral artery occlusive disease. Early re-interventions are largely driven by wound complications and not technical failure.
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