title: Patency and limb salvage after femoral endarterectomy and iliac stenting are not affected by severity of iliac disease.
abstract: The hybrid procedure of femoral endarterectomy and iliac artery stenting (FEIS) has been used as an alternative to traditional open surgical repair of iliofemoral arterial occlusive disease, but whether the severity of the iliac disease component affects long-term results is not well understood.
  
  
  
  This was a retrospective cohort study of patients undergoing FEIS at Geisinger Health System from January 1, 2004, through December 31, 2013, for the treatment of symptomatic iliofemoral atherosclerotic occlusive disease. The cohort was stratified according to the severity of the iliac occlusive disease component into patients with mild iliac disease (group 1) and patients with severe iliac disease (group 2).
  
  
  
  Between January 1, 2004, and December 31, 2013, 99 patients underwent 111 total FEIS procedures. The mean age of the cohort was 67.4 years. Men composed 61% of patients. Indications for surgery were claudication (41%), ischemic rest pain (36%), and tissue loss (23%). At 5 years of follow-up, there was no difference in primary patency (73% in group 1 vs 68% in group 2 [P = .67]) and limb salvage (90% in group 1 vs 92% in group 2 [P = .51]). There was a trend toward higher overall mortality in group 2 patients vs group 1 patients (53% vs 81%; P = .08), but this did not reach statistical significance. Univariate analysis did not identify any device-related or anatomic factors predictive of patency.
  
  
  
  When combined iliofemoral arterial occlusive disease is treated with FEIS, the severity of the iliac disease component does not affect long-term patency or limb salvage.
authors.affiliation: Department of Vascular and Endovascular Surgery, Geisinger Medical Center, Danville, Pa.
authors.forename: Aaron G
authors.initials: AG
authors.lastname: Ilano
authors.affiliation: Department of Vascular and Endovascular Surgery, Geisinger Medical Center, Danville, Pa. Electronic address: rpgarvin@geisinger.edu.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Garvin
authors.affiliation: Department of Vascular and Endovascular Surgery, Geisinger Medical Center, Danville, Pa.
authors.forename: Evan J
authors.initials: EJ
authors.lastname: Ryer
authors.affiliation: Division of Surgery, Geisinger Medical Center, Danville, Pa.
authors.forename: James T
authors.initials: JT
authors.lastname: Dove
authors.affiliation: Department of Vascular and Endovascular Surgery, Geisinger Medical Center, Danville, Pa.
authors.forename: James R
authors.initials: JR
authors.lastname: Elmore
mesh_terms: D000368:Aged; D004691:Endarterectomy / Q000009:adverse effects / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D007383:Intermittent Claudication / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency