Miscellaneous
Endovascular

Open and endovascular treatment of the common femoral artery in a tertiary care center

Selected in Journal of Vascular Surgery by Hortense Chalret du Rieu

This study compares open vs. endovascular revascularisation for CFA disease, focusing on reintervention rates and MALES-free survival. It analyses perioperative complications (hematoma, bleeding, infection) and long-term outcomes, including mortality, major amputation, and reintervention needs.
 

References:

Authors: Nicholas Wells, Addiskidan Hundito, McKenzie R. Tuttle, Dana Alameddine, Edouard Aboian, Isibor Arhuidese, Uwe Fischer, Juan Carlos Perez-Lozada, Raul J. Guzman, Cassius Iyad Ochoa Chaar.

Reference: Volume 79, Issue 6e45-e46June 2024 DOI: 10.1016/j.jvs.2024.03.032

DOI: 10.1016/j.jvs.2024.03.032

Read the abstract

Objective:

The objective was to compare perioperative and long-term outcomes of open vs. endovascular revascularisation for lower limb CFA disease, with a focus on reintervention rates and MALES-free survival.

Study:

Single-center retrospective study based on electronic medical records of patients treated between 2013 and 2020 at Yale New Haven Hospital, involving vascular surgeons, interventional radiologists, and interventional cardiologists.

Population:

The study included patients who underwent lower limb revascularisation involving the common femoral artery (CFA). Patients with aneurysmal diseases, trauma, or procedures requiring femoral access for other indications were excluded. Cardiovascular comorbidities were taken into account, and patients were stratified based on the indication for revascularisation, distinguishing between those treated for claudication and those with chronic limb-threatening ischemia (CLTI).

Endpoints: 

Perioperative outcomes included complications occurring within 30 days of the procedure, such as hematoma, pseudoaneurysm, perioperative bleeding, surgical site infection, pneumonia, and urinary tract infection. Long-term outcomes focused on mortality, major amputation, and the need for reintervention.

Outcomes and conclusion:

Open and endovascular treatment of the common femoral artery in a tertiary care center
Perioperative and long-term outcomes. Source: Journal of Vascular Surgery

The study found that endovascular revascularisation was associated with a higher rate of reintervention, while open surgery led to more significant perioperative complications and longer hospital stays. For patients unfit for open surgery, endovascular therapy provided acceptable short-term outcomes. These findings highlight the need for improved patient selection to optimize treatment strategies. 

Comments:

  • Postoperative complications: Significant complications were observed in the open surgery group. Nguyen et al.1 reported:
    • 3.4 % mortality rate
    • 8 % perioperative wound complications following aortic femoral artery endarterectomy.
  • Long-term reinterventions: More frequent in the endovascular group.
    • Nakama et al.2 and Linni et al.3 showed better primary patency for open surgery (96.6%-100%) vs. endovascular (82.3 % - 84 %).
    • Gouëffic et al.4 found comparable primary patency rates at one year for both methods.
  • Endovascular advantages:
    • Minimally invasive with quicker recovery
    • Improved perioperative safety
    • Shorter hospital stay
  • Reintervention rates: High for both groups:
    • 35 % for endovascular
    • 21 % for open surgery
  • Treatment modalities:
    • Majority of endovascular patients treated with balloons (simple or active)
    • Less than 10 % of endovascular patients received a stent
  • Future analysis: Further examination of patient subgroups may provide deeper insights.

Study limitations:

  • Study design: Retrospective and data collection limitations may introduce bias.
     
  • Selection bias: Treatment choice was influenced by patient preferences.
     
  • Specialty heterogeneity: Variation in specialties could affect patient selection and treatment indication.
     
  • Lack of angiographic data: No information on the extent and severity of aortic femoral artery disease, which would have helped in further evaluating outcomes.

References:

  1. Nguyen and al. Postoperative complications after common femoral endarterectomy. J Vasc Surg. 2015;61:1489e1494.e1. 
  2. Nakama et al. 1-Year outcomes of throm- boendarterectomy vs endovascular therapy for common femoral artery lesions. JACC Cardiovasc Interv. 2022;15:1453e1463. 
  3. Linni and al. Bio- absorbable stent implantation vs. common femoral artery endar- terectomy: early results of a randomized trial. J Endovasc Ther. 2014;21:493e502. 
  4. Gouëffic et al. Stenting or surgery for De Novo common femoral artery stenosis. JACC Cardiovasc Interv. 2017;10:1344e1354.

 

Hortense Chalret

Hortense Chalret du Rieu