SURGICAL ENDARTERECTOMY: THE PREFERRED TREATMENT FOR COMMON FEMORAL ARTERY OCCLUSIVE DISEASE

OBJECTIVES: Proliferation of endovascular techniques with perceived reduction in treatment morbidity repetitively question the precept that surgical endarterectomy(CFE) is the preferred treatment for occlusive disease of the common femoral artery(CFA). This study examined this precept and the efficacy of hybrid procedures performed with CFE arterial access.
METHODS: Technical and hemodynamic success of CFE performed between 2002 and 2005 were determined according to the SVS reporting standards. Primary and assisted patencies were assessed using Kaplan-Meier life-table analysis.
RESULTS: CFE was performed on 65 limbs(mean age 71; male 77%; 28% diabetes; 19% creatinine>1.5mg/dL). Forty-four cases(68%) were performed for claudication and 21 cases(32%) for critical limb ischemia. Thirty-seven cases(57%) were performed as a hybrid procedure where concomitant endovascular interventions were performed. Twenty iliac(TASC A-30%; B-35%; C-20%; D-15%) and 25 femoropopliteal(TASC A-24%; B-60%; C-12%; D-4%) lesions were treated. Technical success was achieved in 100%. Hemodynamic success was achieved in 95% with mean postoperative increase in ABI of 0.24(range:-0.20-0.75). Average hospital stay was 3.2 days(range:1-12 days). Seventy-five percent (6/8) of wounds were healed. There were 3(5%) major complications requiring reintervention, 6(9%) minor complications which were treated conservatively, and no perioperative mortality. With a mean follow-up period of 27 months(range:1-58 months), 1- and 5-year primary patencies were 93% and 91%, respectively. Assisted patency was 100% at both time points. There were no amputations. There was no difference in patencies between CFE performed alone or as a hybrid procedure. Multivariate analysis showed CHF as the only predictor of primary failure(OR 18.2 [1.9-166.7];p=0.01).
CONCLUSIONS: These data suggest CFE should remain the standard of care for occlusive disease of the CFA. Its safety and efficacy establish a standard for comparison with emerging endovascular therapies.