Results of common femoral artery thromboendarterectomy evaluation of a traditional surgical management in the endovascular era.
OBJECTIVE
The aim of this study was to investigate the long-term outcome of common femoral artery thromboendarterectomy in patients with peripheral arterial occlusive disease.


METHODS
The study retrospectively evaluated 713 vessels in 655 patients (75% male; mean age, 69.4 ± 9.5 years) who underwent common femoral thromboendarterectomy from January 2006 until May 2012 in two high-volume vascular centers. Critical limb ischemia was present in 221 patients, and intermittent claudication was present in 434. Three patent tibial arteries, described as runoff vessels, were available in 33% of the cohort, two were present in 28.3%, one runoff vessel was present in 23.4%, and 15.2% (n = 102) showed no runoff option. Hybrid procedures were used to treat 255 limbs (35.8%). The primary end point was primary patency (PP). Secondary patency (SP), limb salvage, and survival were the secondary end points.


RESULTS
Survival rates were 93.9%, 83.0%, 74.1%, and 60.1% at 1, 3, 5, and 7 years, respectively. PP was 78.5% and SP was 89.1% at 7 years. Patency rates were 97.3% (PP) and 97.8% (SP) at 6 months and 90.2% (PP) and 98.3% (SP) at 3 years, respectively, with 76 target lesion revascularizations. No significant difference was demonstrated for PP rates stratified for nonhybrid procedures and hybrid procedures (78.1% vs 78.6%; P = .22) and for critical limb ischemia vs intermittent claudication (76.3% vs 79.4%; P = .20) at 7 years. The mean ± standard deviation ankle-brachial index increased from 0.46 ± 0.3 preoperatively to 0.81 ± 0.2 postoperatively and to 0.77 ± 0.3 at 7 years (P < .001). A total of 20 major amputations were performed, achieving a limb salvage rate of 92.6%. Procedure-related complications occurred in 11.5% during 7 years of follow-up.


CONCLUSIONS
Open surgery for common femoral artery stenosis is safe and effective in the long-term. Endovascular therapy will need to compete with these excellent results.
Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany. Electronic address: carola.wieker@med.uni-heidelberg.de.
Carola Marie
CM
Wieker
Department of Vascular and Endovascular Surgery, University of Münster, Münster, Germany; Department of Vascular Surgery, St. Franziskus-Hospital GmbH, Münster, Germany.
Eva
E
Schönefeld
Department of Vascular and Endovascular Surgery, University of Münster, Münster, Germany; Department of Vascular Surgery, St. Franziskus-Hospital GmbH, Münster, Germany.
Nani
N
Osada
Department of Vascular and Endovascular Surgery, University of Münster, Münster, Germany; Department of Vascular Surgery, St. Franziskus-Hospital GmbH, Münster, Germany.
Christina
C
Lührs
Department of Vascular and Endovascular Surgery, University of Münster, Münster, Germany; Department of Vascular Surgery, St. Franziskus-Hospital GmbH, Münster, Germany.
Roland
R
Beneking
Department of Vascular and Endovascular Surgery, University of Münster, Münster, Germany; Department of Vascular Surgery, St. Franziskus-Hospital GmbH, Münster, Germany.
Giovanni
G
Torsello
Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany.
Dittmar
D
Böckler
D000368:Aged; D000671:Amputation, Surgical; D055109:Ankle Brachial Index; D016638:Critical Illness; D004691:Endarterectomy / Q000009:adverse effects / Q000401:mortality; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005858:Germany; D061847:Hospitals, High-Volume; D006801:Humans; D007383:Intermittent Claudication / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D007511:Ischemia / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency