Common femoral artery endarterectomy in the age of endovascular therapy

Vascular ◽  
2018 ◽  
Vol 26 (6) ◽  
pp. 581-590 ◽  
Author(s):  
Mohamed Elsherif ◽  
Wael Tawfick ◽  
Mohamed Elsharkawi ◽  
Ruth Campell ◽  
Niamh Hynes ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Clinical Success ◽  
Limb Ischemia ◽  
Common Femoral Artery ◽  
Arterial Disease ◽  
Primary Patency ◽  
Secondary Patency ◽  
Patient Demographics ◽  
Included Patient ◽  
Aneurysm Repair

Objectives Common femoral artery endarterectomy (CFE) is the standard treatment for common femoral artery occlusive disease. We aim to assess the medium term outcomes of CFE with or without further concomitant procedures. Design A retrospective observational study. Methods All patients who underwent either isolated CFE (ICFE), CFE with angioplasty for occlusive arterial disease (CFEA) or concomitant CFE with endovascular aortic aneurysm repair (CFEE) were included. Patient demographics follow up, clinical improvement, types of CFE closure, patency rates, and survival-free amputation were noted. Results From 2002 to 2015, 1512 patients were referred with a diagnosis of critical limb ischemia. Of those, 1134 required revascularization. Sixty-one patients underwent 66 CFE. Ten limbs underwent an ICFE, 35 had CFEA, and 21 underwent CFEE. Demographics were comparable in all groups. Twenty-seven were closed primarily, while 39 required patch closure (12 venous, 8 Dacron, 19 biological). Technical success was 100% in ICFEs, 94% in CFEA, and 100% for CFEE ( p = 0.274). Immediate clinical success was 100% in both CFE and CFEE, but was 85.7% in CFEA ( p = 0.035). Immediate hemodynamic success was similar in all three groups ( p = 0.73). Sustained hemodynamic success was 30% in ICFE, 54.3% in CFEA, and 23.8% in CFEE ( p = 0.056). At two years, the primary patency was 90% in ICFE, 74.3% in CFEA, and 100% in CFEE ( p = 0.049). Primary-assisted patency was 90% in ICFE, 82.9% in CFEA, and 100% in CFEE ( p = 0.17). Secondary patency was 90% in ICFE, 94.3% in CFEA, and 100% in CFEE ( p = 0.409). Re-intervention was required in 26.9% of primary closures, versus 12.8% with patch closures ( p = 0.279). Amputation-free survival was 100% in ICFE, 80% in CFEA, and 100% in CFEE ( p = 0.056). Conclusion CFE is a reliable and dependable procedure, even in the absence of good distal runoff.

scholarly journals Hybrid Endarterectomy and Endovascular Therapy in Multilevel Lower Extremity Arterial Disease Involving the Femoral Artery Bifurcation

2012 ◽  
Vol 97 (1) ◽  
pp. 56-64 ◽  
Author(s):  
Junjie Zou ◽  
Yongxiang Xia ◽  
Hongyu Yang ◽  
Hao Ma ◽  
Xiwei Zhang
Keyword(s):  
Lower Extremity ◽  
Femoral Artery ◽  
Ankle Brachial Index ◽  
Common Femoral Artery ◽  
Arterial Disease ◽  
Primary Patency ◽  
Secondary Patency ◽  
Hybrid Procedures ◽  
Lower Extremity Arterial Disease ◽  
Group 3

Abstract The objective of this study was to evaluate the feasibility and efficacy of hybrid therapy (combined endarterectomy-endovascular) in patients with complex peripheral multifocal steno-obstructive vascular disease involving the femoral artery bifurcation. Forty-one combined procedures were performed on 40 patients. Although the common femoral artery was usually treated with endarterectomy, endoluminal procedures were performed proximally in 12 patients (group 1), distally in 18 patients (group 2), and both upward and downward in 11 patients (group 3). Patients underwent clinical assessment and ankle-brachial index measurement thereafter. Primary, assisted-primary, and secondary patency rates at 24 months were 59%, 66%, and 72%, respectively. Primary patency rates were lower in group 3 compared with groups 1 and 2 (P  =  0.015). The limb salvage rate was 86.4% at the end of the follow-up period. Hybrid procedures provide feasible and effective treatment management of selected patients with multilevel lower extremity arterial disease involving the femoral artery bifurcation.

Comparison of Results in Endovascular Interventions for Infrainguinal Lesions: Claudication versus Critical Limb Ischemia

2005 ◽  
Vol 71 (6) ◽  
pp. 474-480 ◽  
Author(s):  
Susan M. Trocciola ◽  
Rabih Chaer ◽  
Rajeev Dayal ◽  
Stephanie C. Lin ◽  
Naveen Kumar ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Critical Limb Ischemia ◽  
Clinical Success ◽  
Ankle Brachial Index ◽  
Duplex Ultrasound ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Transluminal Angioplasty ◽  
Primary Patency ◽  
Endovascular Interventions

This study analyzed clinical success, patency, and limb salvage after endovascular repair in patients treated for chronic limb ischemia presenting with claudication versus critical limb ischemia. Between October 2001 and August 2004, 115 patients (mean age 71) underwent endovascular treatment for infrainguinal arterial disease. Techniques included subintimal angioplasty and transluminal angioplasty with or without stents. Lesions were classified according to Transatlantic InterSociety Consensus. Follow-up (mean 11 months) included physical exam, ankle-brachial index, and duplex ultrasound. Patency rates were determined using Kaplan-Meier and compared by log-rank analysis. One hundred ninety-nine lesions were treated in 121 limbs using percutaneous techniques. Comorbidities were similar except higher rates of diabetes mellitus (67% vs 41%, P < 0.001) and chronic renal insufficiency (22% vs 7%, P < 0.05) were found in critical limb ischemia patients. Primary patency for claudicants was 100 per cent, 98 per cent, and 85 per cent at 3, 6, and 12 months and 89 per cent, 80 per cent, and 72 per cent for critical limb ischemia, respectively ( P = 0.06). Limb salvage was 91 per cent at 12 months for critical limb ischemia patients. Morbidity was similar between groups, and there was no perioperative mortality. Percutaneous intervention for both claudication and critical limb ischemia provides acceptable 12-month patency with limited morbidity.

scholarly journals Directional Atherectomy With Antirestenotic Therapy vs Drug-Coated Balloon Angioplasty Alone for Common Femoral Artery Atherosclerotic Disease

2017 ◽  
Vol 25 (1) ◽  
pp. 92-99 ◽  
Author(s):  
Konstantinos Stavroulakis ◽  
Arne Schwindt ◽  
Giovanni Torsello ◽  
Efthymios Beropoulis ◽  
Arne Stachmann ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Common Femoral Artery ◽  
Primary Patency ◽  
Lesion Length ◽  
Secondary Patency ◽  
Success Rates ◽  
Technical Success ◽  
Chronic Total Occlusions ◽  
Directional Atherectomy ◽  
Drug Coated Balloon

Purpose: To report an experience using directional atherectomy (DA) with antirestenotic therapy (DAART) in the form of drug-coated balloon (DCB) angioplasty vs DCB angioplasty alone in common femoral artery (CFA) occlusive lesions. Methods: A retrospective review was conducted of 47 consecutive patients (mean age 71 years; 26 men) treated between October 2011 and July 2016 using either DCB angioplasty alone (n=26) or DAART (n=21) for CFA lesions. The majority of patients had lifestyle-limiting claudication (14 DCB and 15 DAART). Mean lesion length (39±14 mm DCB and 34±16 mm DAART) and vessel calcification (17/26 DCB and 11/21 DAART) were comparable between the groups. There were 4 chronic total occlusions, all in the DAART group. The main outcome measure was primary patency. Key secondary outcomes were technical success, secondary patency, and freedom from clinically-driven target lesion revascularization (TLR). Results: Technical success rates were 89% following DCB angioplasty and 95% for DAART (p=0.41). The 88% 12-month primary patency and 89% freedom from TLR for DAART were higher than the 68% and 75% estimates following DCB angioplasty alone, but neither difference was statistically significant. However, the secondary patency estimate at 12 months was significantly higher in the DAART group (100% vs 81% for DCB, p=0.03). Bailout stenting (1 DCB vs 1 DAART), vessel perforation (1 DCB vs 0 DAART), access site complications (4 DCB vs 3 DAART), and distal embolization (0 DCB vs 1 DAART) were comparable, whereas DCB angioplasty had more non-flow-limiting dissections (8 vs 1 for DAART, p=0.02). Conclusion: Preparation of the atherosclerotic CFA with directional atherectomy was not associated with statistically significantly higher primary patency or freedom from TLR compared to DCB angioplasty alone at 12 months. Nonetheless, both modalities had promising outcomes in a primarily surgically treated vascular territory.

scholarly journals Simultaneous Hybrid Treatment of Multilevel Peripheral Arterial Disease in Patients with Chronic Limb-Threatening Ischemia

2021 ◽  
Vol 10 (13) ◽  
pp. 2865
Author(s):  
Felice Pecoraro ◽  
David Pakeliani ◽  
Salvatore Bruno ◽  
Ettore Dinoto ◽  
Francesca Ferlito ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Endovascular Treatment ◽  
Hybrid Approach ◽  
Common Femoral Artery ◽  
Arterial Disease ◽  
Major Amputation ◽  
Primary Patency ◽  
Secondary Patency ◽  
Peripheral Arterial

Background: Hybrid treatments (HT) aim to reduce conventional open surgery invasiveness and address multilevel peripheral arterial disease (PAD). Herein, the simultaneous HT treatment in patients with chronic limb-threatening ischemia (CLTI) is reported. Methods: Retrospective analysis, for the period from May 2012 to April 2018, of patients presenting multilevel PAD with CLTI addressed with simultaneous HT. The outcomes of these interventions were measured the following metrics: early technical successes (within 30 days following treatment) and late technical successes (30 days or more following treatment) and included mortality, morbidity symptoms recurrence, and amputation. Survival and patencies were estimated. The median follow-up was 43.77 months. Results: In the 45 included patients, the HT consisted of femoral bifurcation patch angioplasty followed by an endovascular treatment in 38 patients (84.4%) and endovascular treatment followed by a surgical bypass in 7 patients (15.6%). Technical success was 100% without perioperative mortality. Eight (17.8%) patients presented early complications without major amputations. During the follow-up, seven (15.6%) deaths occurred and six patients (13.3%) experienced symptoms recurrence, with five of those patients requiring major amputation. An estimated survival time of 5 years, primary patency, and secondary patency was 84.4%, 79.2%, and 83.3% respectively. Conclusions: Hybrid treatments are effective in addressing patients presenting with multilevel PAD and CLTI. The common femoral artery involvement influences strategy selection. Larger studies with longer-term outcomes are required to validate the hybrid approach, indications, and results.

Long-term Results with the Palmaz Stent in the Superficial Femoral Artery

1995 ◽  
Vol 2 (2) ◽  
pp. 161-167 ◽  
Author(s):  
Patrice Bergeron ◽  
Jean J. Pinot ◽  
Vincent Poyen ◽  
Huber Benichou ◽  
Patrick Khanoyan ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Primary Patency ◽  
Long Term Results ◽  
Secondary Patency ◽  
Critical Ischemia

Purpose: Femoral stenting has demonstrated inconsistent and often disappointing long-term results. To compare our experience, we retrospectively analyzed a series of patients who had Palmaz balloon-expandable stents placed exclusively for superficial femoral artery (SFA) lesions. Methods: From January 1990 to November 1993, 39 patients were evaluated for claudication (79%) or critical ischemia in 42 limbs. The culprit lesions were confined to the SFA: 24 (57%) occlusions and 18 (43%) stenoses, including 3 restenotic lesions. Stenting was elective in 12 (29%) cases: the 3 restenoses and 9 chronic, calcified occlusions. The remaining stents were applied for postangioplasty residual stenosis or angioscopic findings of thrombogenic luminal irregularities. A total of 55 prostheses were successfully implanted. All patients were maintained on ticlopidine and followed by routine duplex scanning. Follow-up angiography was performed in 28 (72%) patients between 4 and 45 months. Results: In the postprocedural period, two acute thromboses (4.8%) occurred within 48 hours in patients who had long occlusions and poor runoff; no other major complications were encountered, for a clinical success rate of 95%. Follow-up evaluation ranged from 4 months to 4 years with a mean of 25 months. The restenosis rate was 19% (34% in occlusions; 10% in stenotic lesions, p = NS). At 24 months, cumulative primary patency was 77% and secondary patency 89%. Conclusions: Palmaz stents performed well in the SFA, demonstrating a low acute thrombosis rate and good long-term patency. The incidence of restenosis is likely to be greater in occlusions than in stenoses.

scholarly journals Determinants of Success and Early Complications in Common Femoral Artery Endarterectomy: A Retrospective Study

Surgeries ◽  
2021 ◽  
Vol 2 (2) ◽  
pp. 180-189
Author(s):  
Marcel Libertus Johannes Quax ◽  
Daniël Eefting ◽  
Herman Joseph Smeets
Keyword(s):  
Retrospective Study ◽  
Femoral Artery ◽  
Clinical Success ◽  
Ankle Brachial Index ◽  
Emergency Operation ◽  
Common Femoral Artery ◽  
Walking Distance ◽  
Safe Procedure ◽  
Hybrid Procedures ◽  
Significant Difference

Introduction: Common femoral artery endarterectomy (CFE) is considered a relatively simple, successful and safe procedure in the literature, but major complications can occur. This retrospective study was performed in order to define characteristics contributing to success or failure after common femoral artery endarterectomy, either performed as a single or hybrid procedure. Methods: A total of 298 patients who underwent CFE in our hospital between 1 January 2011 and 1 January 2017 were included. After exclusion, 227 patients were analyzed. Patient characteristics and outcomes were derived from the patient records. Follow-up was 30 days postoperatively. Outcomes were analyzed by the chi-square test and regression analysis. Clinical success was defined as a combination of technical success, improvement in the ankle-brachial index, increased walking distance and “no complications.” Results: The procedure was clinically successful in 74.4% of the patients, and in 25.6%, a complication occurred. The Rutherford class improved in 65.1% of the patients with 1.6 (SD 1.3) class points. The ankle-brachial index improved in 44.8% of the cases, with an average of 116.6%. The most contributing factors for complications such as death, unplanned amputation, surgical site infection, thrombosis and longer hospital admission were emergency operation and a higher ASA classification. Significantly more complications also occurred in patients with renal failure, congestive heart disease, a high Rutherford classification and previous groin incision. A higher Rutherford class was the only factor correlating with an increase in the ankle-brachial index. When single CFE (48.9% of cases) and hybrid procedures (51.1%) were compared, no significant difference in success or failure was found. Conclusion: Limb ischemia requiring emergency operation and preoperative comorbidity were identified as the most important factors predictive for complications following femoral artery endarterectomy. Combining femoral endarterectomy with an endovascular intervention does not seem to increase the risk of a postoperative complication.

The usefulness and feasibility of placing a clinch knot with a guidewire to achieve temporary hemostasis in arteriovenous dialysis access interventions

2020 ◽  
pp. 112972982095474
Author(s):  
Sung-Joon Park ◽  
Hwan Hoon Chung ◽  
Seung Hwa Lee ◽  
Sung Beom Cho ◽  
Tae-Seok Seo ◽  
...  
Keyword(s):  
Clinical Success ◽  
Primary Patency ◽  
Interventional Treatment ◽  
Secondary Patency ◽  
Dialysis Access ◽  
Hemodialysis Access ◽  
Purse String Suture ◽  
Purse String ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Grafts

Purpose: To evaluate the usefulness and feasibility of using a reversible clinch knot with a guidewire in place rather than eliminating the access route during an arteriovenous hemodialysis access (AV access) intervention using the facing sheath technique. Material and methods: From July 2016 to June 2019, we retrospectively studied 78 sessions performed as interventional treatment for arteriovenous (AV) hemodialysis (HD) access using the “facing-sheath technique.” In all sessions, all antegrade sheaths were removed while a 0.035-inch guidewire remained in place with purse-string suture and the clinch knot. Seventy-two sessions were performed in patients with thrombosed AV accesses (69 arteriovenous grafts [AVGs] and three arteriovenous fistulas [AVFs]), and six sessions were carried out to treat non-thrombosed AV accesses (four AVGs and two AVFs). We evaluated whether proper hemostasis and successful reinsertion of the sheath over the wire into the clinch knot was achieved. Clinical success was defined as achieving prompt restoration of blood flow for AV access, and the postintervention primary and secondary patency were also evaluated. Result: In all 87 clinch knots created in 78 total sessions, proper hemostasis was achieved. All clinch knots that required reversal for additional procedures were successfully reopened (55 clinch knots in 50 sessions). The postintervention primary patency rates at 1, 3, and 6 months, and at 1 year were 77.8%, 68.9%, 55.6%, and 33.3%, respectively. The postintervention secondary patency rates at 1, 3, and 6 months, and also at 1 year were 93.3%, 91.1%, 86.7%, and 86.7%, respectively. Conclusion: Our AV access intervention which used a clinch knot with purse-string suture while the guidewire remained in place was both useful and feasible for maintaining temporary hemostasis.

scholarly journals Perkutaninio šlaunies arterijos kateterizavimo vietinių komplikacijų gydymo taktika

2014 ◽  
Vol 13 (3) ◽  
pp. 177-183
Author(s):  
Ingrida Ašakienė ◽  
Andrius Černauskas ◽  
Nerijus Misonis ◽  
Vaidotas Zabulis ◽  
Robertas Breivis ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Vascular Complications ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Treated Group ◽  
Suspected Coronary Artery Disease ◽  
Femoral Access ◽  
Artery Pseudoaneurysm ◽  
Access Complications ◽  
Local Vascular Complications

Darbo tikslas Nustatyti po intervencinių kardiologinių procedūrų per šlaunies arteriją susidariusių vietinių komplikacijų dažnį, pažeidimo vietos tipą ir optimalų gydymo metodą. Tyrimo medžiaga ir metodai Atlikta 166 pacientų, 2007–2011 metais patyrusių vietinių komplikacijų po kateterizavimo dėl įtariamos vainikinių arterijų patologijos, ligos istorijų duomenų retrospektyvi analizė. Vietinės kraujagyslių komplikacijos diagnozuotos ir gydytos krau­jagyslių chirurgų. Rezultatai Tiriamąją grupę sudarė 96 (57,8 %) moterys ir 70 (42,2 %) vyrų. Vidutinis pacientų amžius buvo 69,1 metų (±11,4 metai). 63 pacientams (38 %) nustatyta sutrikusi kojų arterinė kraujotaka. Po kateterizavimo, atlikto dėl širdies kraujagyslių sistemos pa­tologijos, šlaunies arterijos pseudoaneurizma išsivystė 162 (97,6%), arterioveninė fistulė – 3 (1,8 %), didelė hematoma – 1 pa­cientui. 111 (66,9 %) pacientų gydyta konservatyviai. Chirurginio gydymo prireikė 55 (33,1 %) pacientams. Operuotos 37 mo­terys (67,3 %) ir 18 vyrų (32,7 %). Vidutinis operuotų pacientų amžius buvo 69,9 (±10) metai. Pseudoaneurizmos pašalinimas ir arterijos plastika venos lopu atlikta 33 (60 %) pacientams, pašalinti krešuliai ir užsiūti arterijos defektai 22 (40 %) pacientams. Išvados Vietinių kraujagyslių komplikacijų po intervencinių kardiologinių procedūrų per šlaunies arteriją įvyko 166 pacientams (0,706 %). Dažniausia komplikacija po šlaunies arterijos kateterizavimo – pseudoaneurizma. Pseudoaneurizmos sėkmingai gydytos konservatyviai 111 pacientų (66,9 %). Punkcijos vietos kraujagyslių komplikacijos buvo dažnesnės ligoniams, ku­riems buvo periferinių arterijų aterosklerozinis pažeidimas (p<0,01). Reikšminiai žodžiai: jatrogeninis šlaunies arterijos pažeidimas, pseudoaneurizma Treatment of local complications that develop after catheterisation through the femoral artery punctureIngrida Ašakienė, Andrius Černauskas, Nerijus Misonis, Vaidotas Zabulis, Robertas Breivis, Sigitas Tvarionavičius, Ramūnas Kvietkauskas ObjectiveTo determine what is the rate, type, and the best treatment of local femoral access complications after interventional cardiol­ogy catheterisation procedures through percutaneous femoral artery puncture.Materials and methodsRetrospective analysis of 166 patient medical records was carried out. All the patients underwent coronarography for the suspected coronary artery disease. All of them from 2007 to 2011 developed local femoral access complications. All complica­tions were diagnosed and treated by vascular surgeons.ResultsThe study group consisted of 96 (57.8%) women and 70 (42.2%) men. The average age of the patients was 69.1 years (±11.4 years). Limb ischemia was determined in 63 patients (38%). After catheterisation due to cardiovascular pathology, femoral artery pseudoaneurysm developed in 162 patients (97.6%), arteriovenous fistula in 3 patients (1.8%), and massive hematoma in 1 patient; 111 patients (66.9%) were treated conservatively and 55 (33.1%) surgically. The surgically treated group consisted of 37 women (67.3%) and 18 men (32.7%). The average age of surgically treated patients was 69.9 (±10) years. Pseudoaneurysm removal and venous patch plasty were performed in 33 patients (60%). The removal of blood clots and direct suture of arterial defects were performed in 22 patients (40%).Conclusions166 patients (0.706%) developed local vascular complications after cardiovascular interventions through the femoral artery. Pseudoaneurysm was the most common complication after femoral artery catheterisation. Conservative treatment was suc­cessful in 111 patients (66.9%). Local vascular complications of the puncture site were more common in patients with a pe­ripheral arterial disease (p < 0.01).Key words: iatrogenic femoral artery damage, pseudoaneurysm

The Mid-Thigh Loop Arteriovenous Graft: Patient Selection, Technique, and Results

2006 ◽  
Vol 72 (9) ◽  
pp. 825-828 ◽  
Author(s):  
John D. Scott ◽  
David L. Cull ◽  
Corey A. Kalbaugh ◽  
Christopher G. Carsten ◽  
Dawn Blackhurst ◽  
...  
Keyword(s):  
Patient Selection ◽  
Femoral Artery ◽  
Common Femoral Artery ◽  
Infectious Complications ◽  
Secondary Patency ◽  
Graft Placement ◽  
Femoral Vessels ◽  
Common Operation ◽  
The Common ◽  
Av Graft

As patient longevity on hemodialysis has increased, surgeons are increasingly challenged to provide vascular access to patients who have exhausted options for access in the upper extremity. A common operation performed on these patients has been the loop thigh arteriovenous (AV) graft based off the common femoral vessels. However, there are several disadvantages of placing prosthetic grafts in proximity to the groin. Our group has modified the thigh loop AV graft procedure by moving the anastomoses to the mid-superficial femoral artery and vein. The advantage of this location is that it preserves the proximal femoral vessels for graft revision and avoids the node-bearing tissue and overhanging panniculus of the groin. The purpose of this study was to review our technique, patient selection, and experience with the mid-thigh loop AV graft procedure. Between 2001 and 2003, 46 mid-thigh loop AV grafts were placed in 38 patients. Patient hospital, office, and dialysis clinic records were reviewed. The primary and secondary patency for AV grafts in this study by life-table was 40 per cent and 68 per cent at 1 year and 18 per cent and 43 per cent at 2 years. There were 10 infections (21%) requiring graft removal. Four patients underwent subsequent placement of a proximal loop thigh AV graft after mid-thigh graft failure. Patient survival was 86 per cent at 1 year and 82 per cent at 2 years. There were no patient deaths related to thigh graft placement. Our results with the mid-thigh loop AV graft compare favorably with published results for thigh loop AV grafts. The procedure preserves the proximal vasculature, permitting graft revision or subsequent proximal graft placement, and may be associated with fewer infectious complications. The mid-thigh loop AV graft procedure should be considered before placement of a thigh loop AV graft based off the common femoral artery and vein.

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