title: Isolated endarterectomy of femoral bifurcation in critical limb ischemia: is restoration of inline flow essential?
abstract: This retrospective study reviews clinical outcomes of isolated common femoral endarterectomy (CFE) for critical limb ischemia (CLI), in particular whether poor runoff and inability to restore inline flow has negative impact. In 30 patients, runoff was assessed on preoperative angiograms and categorized into groups based on Society of Vascular Surgery criteria. Data were evaluated using Cox Regression survival analysis. Freedom from secondary revascularization was not affected by runoff score (hazard ratio for compromised and poor groups being 1.8 (95% CI 0.16 to 20.8) and 1.47 (95% CI 0.09 to 24.3), respectively; P = .894). Distal inline flow was not achieved in 25 (83%) patients, but this was not associated with significantly worse outcome (P = .295, log-rank test). In conclusion, CFE can be performed in CLI with high technical success and there is no significant effect of runoff score on recurrence of symptoms. Limb salvage can be achieved even if options to restore inline flow are limited.
authors.affiliation: Department of Vascular Surgery, Royal Free Hampstead NHS Trust Hospital, Pond Street, London.
authors.forename: Mital
authors.initials: M
authors.lastname: Desai
authors.forename: Janice
authors.initials: J
authors.lastname: Tsui
authors.forename: Meryl
authors.initials: M
authors.lastname: Davis
authors.forename: Fiona
authors.initials: F
authors.lastname: Myint
authors.forename: Alan
authors.initials: A
authors.lastname: Wilson
authors.forename: Daryll M
authors.initials: DM
authors.lastname: Baker
authors.forename: George
authors.initials: G
authors.lastname: Hamilton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D015331:Cohort Studies; D004691:Endarterectomy; D005260:Female; D005263:Femoral Artery; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome