title: The Role of Common Femoral Artery Endarterectomy in the Endovascular Era.
abstract: BACKGROUND
  The purpose of this study was to review our experiences treating peripheral artery disease (PAD) by common femoral artery endarterectomy (CFE) with and without endovascular therapy (EVT), and to describe the role of CFE in the endovascular era.
  
  
  METHODS
  We retrospectively reviewed a contemporary series of 38 limbs from January 2010 to September 2014. Clinical outcomes of primary patency, assisted primary patency, limb salvage, and survival were analyzed with the Kaplan-Meier method. Multivariable perioperative predictors of primary patency were identified using the stepwise Cox proportional hazards regression model.
  
  
  RESULTS
  Hemodynamic success was achieved in 36 of the 38 limbs (95%). The mean ankle brachial pressure index improved significantly, rising from 0.56 ± 0.04 preoperatively to 0.89 ± 0.04 postoperatively (P = 0.0001). Overall primary and assisted primary patency rates, respectively, were 90% and 100% at 12 months and 85% and 94% at 24 months. There was no significant difference in primary patency rate between isolated CFE and hybrid CFE plus EVT. Both limb salvage and survival rates were 97% at 12 months and 97% at 24 months. Multivariate Cox regression analysis revealed that no clinical or perioperative risk factors were predictive of decreased primary patency.
  
  
  CONCLUSIONS
  CFE is a safe, effective, and durable procedure for common femoral artery disease, and hybrid CFE plus EVT can be a valid alternative to open surgical bypass for multilevel occlusive artery disease. These observations stress that CFE plays a vital role in the management of PAD even in the endovascular era.
authors.affiliation: Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan; Department of Surgery, Eniwa Midorino Clinic, Eniwa, Japan. Electronic address: toshiyanishibe@yahoo.co.jp.
authors.forename: Toshiya
authors.initials: T
authors.lastname: Nishibe
authors.affiliation: Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Maruno
authors.affiliation: Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Akinari
authors.initials: A
authors.lastname: Iwahori
authors.affiliation: Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Fujiyoshi
authors.affiliation: Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Shun
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takahashi
authors.affiliation: Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ogino
authors.affiliation: Department of Surgery, Eniwa Midorino Clinic, Eniwa, Japan.
authors.forename: Masayasu
authors.initials: M
authors.lastname: Nishibe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004691:Endarterectomy; D057510:Endovascular Procedures; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D014654:Vascular Patency