title: Acute and medium-term outcomes of endovascular therapy of obstructive disease of diverse etiology of the common femoral artery.
abstract: BACKGROUND
  Common femoral endarterectomy is regarded as the standard revascularization strategy for the treatment of common femoral artery (CFA) disease. The availability of a variety of endovascular tools has resulted in an increased number of patients with CFA disease being treated using an endovascular strategy. We sought to evaluate clinical outcomes in a contemporary series of patients who were treated for CFA disease using an endovascular-first approach.
  
  
  METHODS
  All patients with obstructive CFA disease who were treated using endovascular therapy were retrospectively identified from a peripheral interventional database. Baseline patient characteristics, anatomic details, procedural data, and clinical outcomes were assessed. Kaplan-Meier (KM) curves for mortality, amputation-free survival, and primary and secondary patency were generated.
  
  
  RESULTS
  Between 2006 and 2011, a total of 30 patients underwent 31 CFA procedures. The primary etiologies of CFA obstruction were atherosclerosis (58%), access-site-related complication (32%), and thromboembolism (10%). Patients presented with severe claudication (60%), critical limb ischemia (13%), or acute limb ischemia (27%). The procedure was technically successful in 90% of cases with major complications in two (7%) patients. There was no procedure-related mortality. The KM estimate of survival and amputation-free survival at 1 year was 96% (± 4%) and 96% (± 4%), respectively. In those patients who had a successful revascularization, the overall 1-year estimate for primary and secondary patency was 88% (± 6) and 92% (± 5%), respectively. There was a nonsignificant trend toward lower patency in patients treated for atherosclerotic disease compared to those with access-site-related complications and thromboembolic disease at 2-year follow-up (76 vs. 100%, P = 0.08).
  
  
  CONCLUSIONS
  Endovascular therapy for treatment of obstructive disease of the CFA is associated with a high rate of acute technical success. Primary patency rates in the cohort treated for access-site-related complications and thromboembolic disease are excellent and support an endovascular-first approach for this patient subset. Based on lower patency rates, surgical endarterectomy for the treatment of atherosclerotic disease in the CFA remains the gold standard in patients with normal surgical risk.
authors.affiliation: Division of Cardiology, University of Colorado Denver, Aurora, Colorado 80045, USA. phil.dattilo@gmail.com
authors.forename: Philip B
authors.initials: PB
authors.lastname: Dattilo
authors.forename: Thomas T
authors.initials: TT
authors.lastname: Tsai
authors.forename: R
authors.initials: R
authors.lastname: Kevin Rogers
authors.forename: Ivan P
authors.initials: IP
authors.lastname: Casserly
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D050197:Atherosclerosis / Q000150:complications / Q000628:therapy; D006328:Cardiac Catheterization / Q000009:adverse effects; D002406:Catheterization, Peripheral / Q000009:adverse effects; D004691:Endarterectomy; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013923:Thromboembolism / Q000150:complications / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency