Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jan 15:8:2050312119900860.
doi: 10.1177/2050312119900860. eCollection 2020.

Long-term results after femoral thrombendarterectomy combined with simultaneous endovascular intervention in intermittent claudication and critical ischemia

Martin Altreuther  1   2 , Erney Mattsson  1   2
Affiliations

Long-term results after femoral thrombendarterectomy combined with simultaneous endovascular intervention in intermittent claudication and critical ischemia

Martin Altreuther et al. SAGE Open Med. .

Abstract

Objective: This population-based retrospective cohort study investigates long-term results of femoral thrombendarterectomy combined with simultaneous endovascular intervention of the iliac or femoropopliteal vessels, or both, with focus on freedom from recurrent intervention, limb salvage and survival.

Methods: All patients undergoing femoral thrombendarterectomy and simultaneous endovascular intervention between 1999 and 2013 were included. Stratification was according to clinical symptoms, intermittent claudication or critical ischemia, with subgroups for rest pain and ulcer/gangrene, and for type of endovascular intervention, iliac, femoropopliteal or both. We assessed technical success, 30-day complications, freedom from recurrent intervention, survival and amputation free survival in all patients. Limb salvage was assessed in patients with critical ischemia.

Results: We identified 151 operations in 143 patients with a total of 164 limbs treated. A total of 13 patients had bilateral and 8 patients had subsequent contralateral operations. Indication was intermittent claudication in 87 (57.6%) and critical ischemia in 64 (42.4%) operations. Thirty-day mortality, only observed in critical ischemia, was 5/64 (7.8%). Freedom from recurrent intervention after 5 years was 91% in intermittent claudication and 70% in critical ischemia. In total, 84% of the patients with claudication were improved at the end of the study. Limb salvage at 5 years was 75% in critical ischemia, 93% in rest pain and 64% in patients with ulcer or gangrene.

Conclusion: Femoral thrombendarterectomy combined with endovascular iliac or femoropopliteal intervention has good and durable results in intermittent claudication and critical ischemia, especially in patients with rest pain. In most cases, a single operation is sufficient.

Keywords: Hybrid operation; amputation free survival; critical limb ischemia; hybrid revascularization; intermittent claudication; limb salvage.

PubMed Disclaimer

Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure.1.
Figure.1.
Treatment pathway and results for all limbs treated.
Figure 2.
Figure 2.
Freedom from reintervention depending on indication.
Figure 3.
Figure 3.
Limb salvage in after hybrid operation depending on indication.
Figure 4.
Figure 4.
Amputation free survival after hybrid operation depending on indication.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Dosluoglu HH, Lall P, Cherr GS, et al. Role of simple and complex hybrid revascularization procedures for symptomatic lower extremity occlusive disease. J Vasc Surg 2010; 51(6): 1425–1435. - PubMed
    1. Balaz P, Rokosny S, Wohlfahrt P, et al. Early and late outcomes of hybrid endovascular and open repair procedures in patients with peripheral arterial disease. Vasa 2013; 42(4): 292–300. - PubMed
    1. Piazza M, Ricotta JJ, II, Bower TC, et al. Iliac artery stenting combined with open femoral endarterectomy is as effective as open surgical reconstruction for severe iliac and common femoral occlusive disease. J Vasc Surg 2011; 54(2): 402–411. - PubMed
    1. Aho PS, Venermo M. Hybrid procedures as a novel technique in the treatment of critical limb ischemia. Scand J Surg 2012; 101(2): 107–113. - PubMed
    1. Joh JH, Joo SH, Park HC. Simultaneous hybrid revascularization for symptomatic lower extremity arterial occlusive disease. Exp Ther Med 2014; 7(4): 804–810. - PMC - PubMed

LinkOut - more resources