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. 2022 Nov 21;11(22):6873.
doi: 10.3390/jcm11226873.

Long-Term Outcomes following Common Femoral Endarterectomy

Takuya Hashimoto  1 , Satoshi Yamamoto  2 , Masaru Kimura  1 , Masaya Sano  1 , Osamu Sato  1 , Juno Deguchi  1
Affiliations

Long-Term Outcomes following Common Femoral Endarterectomy

Takuya Hashimoto et al. J Clin Med. .

Abstract

Thromboendarterectomy of the common femoral artery (CFA) for occlusive disease is a crucial procedure in vascular surgery. As an outcome reference for emerging endovascular procedures and new devices, we need more robust evidence of the outcome of this gold standard technique. The purpose of this study was to report 10-year results after femoral endarterectomy (FEA). A retrospective review of medical records at our institution identified eighty consecutive patients (91 limbs) who underwent FEA for CFA lesions. Indications for FEA included 50 limbs (55%) for intermittent claudication (IC) and 39 limbs (43%) with chronic limb-threatening ischemia (CLTI). Two limbs (2%) underwent FEA to prevent hemodynamic steal during extra-anatomical bypass. Adjunctive procedures included endovascular therapy in 32%. CFAs were closed with patch angioplasty in 44%. With a mean follow-up period of 39 months, the survival rates at 3 and 8 years were 85% and 77%, respectively. Limb salvage rates were 92% and 87%. Primary patencies were 98% and 84%. Freedom from target lesion revascularization was 95% at 3 years and 91% at 8 years. Our findings support the durability of FEA, with comparable long-term procedural results in CLTI patients as well as IC patients. Since the FEA is a gate maneuver for hybrid revascularization in CLTI patients, our findings support a strategy combining open and endovascular approaches. Femoral endarterectomy remains a durable solution for common femoral occlusive disease in IC and CLTI in the era of endovascular therapy.

Keywords: common femoral endarterectomy; peripheral artery disease; revascularization.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Inclusion number of limbs per year.
Figure 2
Figure 2
Ten-year outcome after femoral endarterectomy. (A) Survival; (B) limb salvage; (C) primary patency; (D) freedom from target lesion revascularization. Numbers at risk are shown above the x-axis.
Figure 3
Figure 3
Ten-year outcomes after femoral endarterectomy, according to initial limb status. (A) Survival, p = 0.0010; (B) limb salvage, p = 0.0002; (C) primary patency, p = 0.8992; (D) freedom from target lesion revascularization, p = 0.3182. IC, intermittent claudication; CLTI, chronic limb-threatening ischemia. Numbers at risk are shown above the x-axis.
Figure 4
Figure 4
Common femoral endarterectomy with extended profundaplasty using a bovine pericardial patch. (A) Trans-arterial angiography of the left femoral artery. Stenosis at common femoral artery (arrowhead) and occlusion of deep femoral artery (arrow). (B) Intraoperative picture of the left femoral artery. (C) Reconstruction by patch-angioplasty using a bovine pericardial patch.
See this image and copyright information in PMC

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