Long-term outcome after isolated endarterectomy of the femoral bifurcation.
BACKGROUND
Long-term outcome after endarterectomy of the femoral bifurcation has not been widely investigated, and the aim of this study was to assess its late results from a community-wide perspective.


METHODS
Between 1983 and 2006 111 isolated endarterectomies of the common femoral artery and/or the proximal part of the superficial femoral artery or profunda femoris were performed in 90 patients at the Oulu University Hospital, Oulu, Finland. A total of 77 limbs were treated surgically for claudication and 34 others for critical limb ischemia. Angiographic findings of 100 extremities were evaluated.


RESULTS
The in-hospital mortality rate was 1.8%. The mean follow-up period was 5.9 years. At 5-, 10-, and 15-year follow-up the overall survival was 60.5%, 32.7%, and 17.6%, respectively (S.E < 0.05). A C-reactive protein value > or = 10 mg/l was predictive of poor late survival (p = 0.008). Limb salvage rates after isolated femoral endarterectomy at 5-, 10-, and 15-year follow-up were 93.7%, 93.7%, and 85.2%, respectively (S.E. < 0.08). Critical limb ischemia (p = 0.006) and current smoking (p = 0.027) were independent predictors of major lower limb amputation. A total of 41 limbs were subjected to ipsilateral vascular procedures after femoral endarterectomy, only one of which was re-endarterectomy. Freedom from any ipsilateral revascularization procedure at 5-, 10-, and 15-year follow-up was calculated at 68.0%, 50.6%, and 42.5%, respectively (S.E. < 0.08). The overall linearized rate of reintervention on the ipsilateral limb was 0.16 +/- 0.44/year. The linearized rate among patients who had any ipsilateral vascular reintervention was 0.43 +/- 0.66/year.


CONCLUSIONS
Isolated femoral endarterectomy is a rather low-risk and durable procedure. However, a significant number of reinterventions distal or proximal to the endarterectomized site can be expected in one third of patients.
Kechagias
Aristotelis
A
Department of Surgery, Division of Cardiothoracic and Vascular Surgery, Oulu University Hospital, P.O. Box 21, 90029, Oulu, Finland.
Ylönen
Kari
K
Biancari
Fausto
F
D000792:Angiography; D002097:C-Reactive Protein / Q000378:metabolism; D004691:Endarterectomy / Q000379:methods* / Q000401:mortality; D005263:Femoral Artery / Q000601:surgery*; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007383:Intermittent Claudication / Q000401:mortality / Q000601:surgery*; D007511:Ischemia / Q000401:mortality / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D023821:Limb Salvage; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012086:Reoperation; D015996:Survival Rate; D016896:Treatment Outcome
D002097:C-Reactive Protein