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Suwanruangsri V, Bokerd S, Chanchitsopon V, Jowcharoen S. Endovascular treatment with interwoven nitinol stent for common femoral artery lesions: 2-year outcomes of a single center experience. Vascular 2024:17085381241236564. [PMID: 38409957 DOI: 10.1177/17085381241236564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
OBJECTIVE The study aimed was to report 2-year outcomes of endovascular treatment with interwoven nitinol (Supera™) stent for common femoral artery (CFA) lesions. METHODS We reviewed the clinical data of 20 patients who presented with CFA stenosis or occlusion and underwent balloon angioplasty followed by Supera™ stenting in CFA between February 2016 and January 2022. The outcomes were evaluated in these patients in terms of technical success, post-intervention complications, reintervention, and cumulative patency (1 year, and 2 years). RESULTS The study included 20 patients (22 lesions) who presented with isolated CFA lesions (3), iliac lesions involving CFA (6), superficial femoral artery (SFA) lesions involving CFA (8), and extensive lesions from the iliac artery to SFA (5). There were 16 men (80%) with a mean age of 69.7 years (range, 34-83). Hypertension, smoking, and diabetes were found in 15 (75%), 7 (35%), and 7 patients (35%), respectively. Clinical presentations were Rutherford stage 5 (9, 45%), Rutherford stage 4 (5, 25%), Rutherford stage 6 (4, 20%), and Rutherford stage 3 (2, 10%). Technical success was achieved in all patients (100%). The procedures for treatment were isolated CFA Supera™ stenting (1, 4.5%), CFA plus DFA Supera™ stenting (jailed SFA) (2, 9.1%), CFA plus SFA Supera™ stenting (jailed DFA) (8, 36.4%), CFA Supera™ stenting plus bare iliac stenting (Astron) (6, 27.3%), CFA plus SFA Supera™ stenting (jailed DFA) plus bare iliac stenting (Astron) (5, 22.7%), and additional DFA angioplasty (7, 31.8%). The rate of in-hospital mortality and morbidity were 0% and 10%, respectively. Distal embolization after pre-dilatation occurred in 1 patient, and cerebral infarction occurred 12 h after the procedure in 1 patient. The mean follow-up time was 23 months (range, 2-64). During the follow-up period, in-stent occlusion occurred in 2 patients at 9 and 46 months. Re-intervention was performed in 1 patient due to recurrent symptom of claudication. The cumulative primary patency at 1 year and 2 years were 93.3% and 93.3%, respectively. CONCLUSION Endovascular treatment with interwoven nitinol (Supera™) stent for CFA lesions was associated with acceptable outcomes at 2 years.
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Affiliation(s)
- Veera Suwanruangsri
- Division of Vascular Surgery, Department of Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - Surakiat Bokerd
- Division of Vascular Surgery, Department of Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - Virapat Chanchitsopon
- Division of Vascular Surgery, Department of Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - Sirakarn Jowcharoen
- Division of Vascular Surgery, Department of Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
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Okazaki T, Kobayashi T, Mochizuki S, Ozawa M, Maeda K, Inoue R, Futagami D, Tachibana H, Sato K, Hiraoka T, Tomota M, Emura S, Shimizu H, Takasaki T, Kodama H, Takahashi S. Clinical Outcomes of Common Femoral Thromboendarterectomy with Bovine Pericardium Patch Angioplasty. Ann Vasc Surg 2024; 98:194-200. [PMID: 37385339 DOI: 10.1016/j.avsg.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/26/2023] [Accepted: 06/01/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND The purpose of the study is to evaluate the efficacy of thromboendarterectomy (TEA) for common femoral occlusive disease using bovine pericardium patch angioplasty. METHODS The subjects were patients who underwent TEA for common femoral occlusive disease with bovine pericardium patch angioplasty from October 2020 to August 2021. The study had a prospective, multicenter, and observational design. The primary end point was primary patency (freedom from restenosis). The secondary end points were secondary patency, amputation-free survival (AFS), postoperative wound complication, hospital death within 30 days, and major adverse cardiovascular events (MACE) within 30 days. RESULTS Forty-seven TEA procedures with a bovine patch were performed in 42 patients (34 males; median age, 78 years; diabetes mellitus, 57%; end-stage renal disease with hemodialysis, 19%). Clinical presentations were intermittent claudication (68%) and critical limb-threatening ischemia (32%). Sixteen (34%) limbs underwent TEA alone and 31 (66%) underwent a combined procedure. Surgical site infection (SSI) occurred in 4 limbs (9%) and lymphatic fistulas in 3 limbs (6%). One limb with SSI required surgical debridement 19 days after the procedure, and 1 limb (2%) without postoperative wound complications required additional treatment due to acute bleeding. Hospital death within 30 days occurred in 1 case due to panperitonitis. There was no MACE within 30 days. Claudication was improved in all cases. Postoperative ABI of 0.92 [0.72-1.00] was significantly higher than the preoperative value (P < 0.001). The median follow-up period was 10 months [9-13 months]. One limb (2%) required additional endovascular therapy due to stenosis at the endarterectomy site at 5 months postoperatively. Primary and secondary patencies were 98% and 100% at 12 months, respectively, and the AFS rate was 90% at 12 months. CONCLUSIONS Common femoral TEA with bovine pericardium patch angioplasty has satisfactory clinical outcomes.
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Affiliation(s)
- Takanobu Okazaki
- Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hatsukaichi-shi, Hiroshima, Japan.
| | - Taira Kobayashi
- Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hatsukaichi-shi, Hiroshima, Japan
| | - Shingo Mochizuki
- Department of Cardiovascular Surgery, Akane-Foundation Tsuchiya General Hospital, Hiroshima-shi, Hiroshima, Japan
| | - Masamichi Ozawa
- Department of Cardiovascular Surgery, Hiroshima Prefectural Hospital, Hiroshima-shi, Hiroshima, Japan
| | - Kazuki Maeda
- Department of Cardiovascular Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima-shi, Hiroshima, Japan
| | - Risa Inoue
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima-shi, Hiroshima, Japan
| | - Daisuke Futagami
- Department of Cardiovascular Surgery, Fukuyama Cardiovascular Hospital, Fukuyama-shi, Hiroshima, Japan
| | - Hitoshi Tachibana
- Department of Cardiovascular Surgery, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima-shi, Hiroshima, Japan
| | - Katsutoshi Sato
- Department of Cardiovascular Surgery, JA Onomichi General Hospital, Onomichi-shi, Hiroshima, Japan
| | - Toshifumi Hiraoka
- Department of Cardiovascular Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure-shi, Hiroshima, Japan
| | - Mayu Tomota
- Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hatsukaichi-shi, Hiroshima, Japan
| | - Shogo Emura
- Department of Cardiovascular Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima-shi, Hiroshima, Japan
| | - Haruna Shimizu
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima-shi, Hiroshima, Japan
| | - Taiichi Takasaki
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima-shi, Hiroshima, Japan
| | - Hiroshi Kodama
- Department of Cardiovascular Surgery, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima-shi, Hiroshima, Japan
| | - Shinya Takahashi
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima-shi, Hiroshima, Japan
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Kobayashi T, Takahara M, Fujimura N, Ichihashi S, Kudo T, Okadome J, Obara H, Nakama T, Suzuki K, Yamaoka T. Comparison of Clinical Outcomes in Patients Undergoing Common Femoral Thromboendarterectomy With or Without Patch Angioplasty. Eur J Vasc Endovasc Surg 2023; 65:870-877. [PMID: 36967011 DOI: 10.1016/j.ejvs.2023.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/10/2023] [Accepted: 03/21/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Surgical thromboendarterectomy (TEA) is the standard treatment for an occlusive lesion of the common femoral artery (CFA). However, there is limited knowledge on the need for patch angioplasty in CFA TEA. The objective of this study was to compare the peri-operative and two year results of CFA TEA with or without patch angioplasty. METHODS A multicentre retrospective observational study was performed at 34 Japanese centres. Comparisons were made between patients undergoing CFA TEA with or without patch angioplasty after propensity score matching (PSM). The primary endpoints were primary patency and freedom from target lesion revascularisation (TLR) of the TEA lesion. The secondary endpoints were hospital outcomes, limb salvage, and overall survival. RESULTS Between 2018 and 2020, 428 TEA procedures (237 with patch angioplasty and 191 with primary closure) were performed. PSM extracted 151 pairs with no significant intergroup differences in baseline characteristics. Peri-operative death and complications occurred in 0.7% vs. 1.3% (p = 1.0) and 6.0% vs. 6.6% (p = 1.0), respectively. The follow up rate was 96% over a median follow up of 14.9 months (interquartile range 8.3, 24.3). Loss of primary patency occurred in 18 patients. The two year primary patency of patch angioplasty cases was statistically significantly higher than that of primary closure cases (97.0% vs. 89.9%; p = .021). TLR was performed in 14 patients. The two year freedom from TLR in patch angioplasty cases was also statistically significantly higher than in primary closure cases (98.6% vs. 92.9%; p = .003). During follow up, seven limbs required major amputation and 40 patients died. There was no statistically significant difference in limb salvage and survival between the two groups after PSM. CONCLUSIONS This is the first report to show that patch angioplasty may decrease re-stenosis and target lesion revascularisation of CFA TEA lesions.
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Affiliation(s)
- Taira Kobayashi
- Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hatsukaichi, Japan.
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Naoki Fujimura
- Department of Vascular Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Shigeo Ichihashi
- Department of Radiology, Nara Medical University, Kashihara, Japan
| | - Toshifumi Kudo
- Division of Vascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Jun Okadome
- Department of Vascular Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tatsuya Nakama
- Department of Cardiology, Tokyo Bay Medical Center, Urayasu, Japan
| | - Kenji Suzuki
- Department of Cardiology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Terutoshi Yamaoka
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, Ehime, Japan
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McGinigle KL, Spangler EL, Ayyash K, Arya S, Settembrini AM, Thomas MM, Dell KE, Swiderski IJ, Davies MG, Setacci C, Urman RD, Howell SJ, Garg J, Ljungvist O, de Boer HD. A framework for perioperative care for lower extremity vascular bypasses: A Consensus Statement by the Enhanced Recovery after Surgery (ERAS®) Society and Society for Vascular Surgery. J Vasc Surg 2023; 77:1295-1315. [PMID: 36931611 DOI: 10.1016/j.jvs.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 03/17/2023]
Abstract
The Society for Vascular Surgery and the Enhanced Recovery After Surgery (ERAS) Society formally collaborated and elected an international, multi-disciplinary panel of experts to review the literature and provide evidence-based suggestions for coordinated perioperative care for patients undergoing infrainguinal bypass surgery for peripheral artery disease. Structured around the ERAS core elements, 26 suggestions were made and organized into preadmission, preoperative, intraoperative, and postoperative sections.
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Affiliation(s)
- Katharine L McGinigle
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Emily L Spangler
- Department of Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Katie Ayyash
- Department of Perioperative Medicine (Merit), York and Scarborough Teaching Hospitals NHS Foundation Trust, York, United Kingdom
| | - Shipra Arya
- Department of Surgery, School of Medicine, Stanford University, Palo Alto, CA
| | | | - Merin M Thomas
- Lenox Hill Hospital, Northwell Health, New Hyde Park, NY
| | | | | | - Mark G Davies
- Department of Surgery, Joe R. & Teresa Lozano Long School of Medicine, University of Texas Health Sciences Center, San Antonio, TX
| | - Carlo Setacci
- Department of Surgery Surgery, University of Siena, Siena, Italy
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA
| | - Simon J Howell
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, United Kingdom
| | - Joy Garg
- Department of Vascular Surgery, Kaiser Permanente San Leandro, San Leandro, CA
| | - Olle Ljungvist
- Department of Surgery, Orebro University, Orebro, Sweden
| | - Hans D de Boer
- Department of Anesthesiology, Pain Medicine, and Procedure Sedation and Analgesia, Martini General Hospital Groningen, Groningen, the Netherlands
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Yamamoto Y, Uchiyama H, Oonuki M. Outcomes of Femoral Endarterectomy with Superficial Tributary Vein Patch Angioplasty. Ann Vasc Surg 2023; 90:197-203. [PMID: 36473670 DOI: 10.1016/j.avsg.2022.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/18/2022] [Accepted: 10/26/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Surgical endarterectomy is still considered the gold standard for the treatment of common femoral artery (CFA) occlusive disease. The present study evaluated the outcomes of CFA endarterectomy with patch angioplasty using the superficial tributary vein (STV) of the great saphenous vein. METHODS This was a single-center, retrospective study. We reviewed our institutional data of consecutive patients who received elective CFA endarterectomy between January 2014 and December 2021. RESULTS During the study period, CFA endarterectomy with STV patch angioplasty was performed in 49 limbs in 42 patients, including 33 limbs (67.3%) treated by hybrid procedure combining CFA endarterectomy with endovascular treatment. Technical success was achieved in 100% of subjects. The median ankle brachial pressure index improved from 0.57 (0.43-0.67) preoperatively to 0.96 (0.77-0.99) postoperatively (P < 0.001). The 30-day mortality rate was 2.0% (n = 1). The overall 30-day complication rate was 6.1% (n = 3) and the local complication rate was 2.0% (n = 1). No aneurysmal dilatation or rupture of an STV patch was observed at a median follow-up of 22 months. The 1-year and 2-year primary patency rates were 97.4% and 97.4%, respectively. CONCLUSIONS The efficacy and patency of CFA endarterectomy with STV patch angioplasty were similar to those of conventional CFA endarterectomy. STV patch angioplasty is a durable procedure and may improve the outcomes of CFA endarterectomy through a reduction in the risk of postoperative local complications by avoiding the use of a prosthetic patch and by preserving the main great saphenous vein.
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Affiliation(s)
- Yohei Yamamoto
- Department of Vascular Surgery, Tsuchiura Kyodo General Hospital, Ibaraki, Japan.
| | - Hidetoshi Uchiyama
- Department of Vascular Surgery, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Masahiro Oonuki
- Department of Vascular Surgery, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
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Gouëffic Y, Nasr B. Commentary to Eligibility of Common Femoral Artery Atherosclerotic Disease For Endovascular Treatment: The CONFESS Study. Eur J Vasc Endovasc Surg 2022; 64:692. [PMID: 36170942 DOI: 10.1016/j.ejvs.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Yann Gouëffic
- Groupe Hospitalier Paris St Joseph, Department of Vascular and Endovascular Surgery, Paris, France.
| | - Bahaa Nasr
- CHU Brest, Service de Chirurgie Vasculaire, Brest, France
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7
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Marie Hoffmann-Wieker C, Ronellenfitsch U, Rebelo A, Görg N, Schwarzer G, Ballotta E, Gouëffic Y, Böckler D. Open Surgical Thrombendarterectomy Versus Endovascular Treatment in Occlusive Processes of the Femoral Artery Bifurcation. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:803-809. [PMID: 36424715 PMCID: PMC9906024 DOI: 10.3238/arztebl.m2022.0331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/07/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The standard treatment of occlusive processes of the femoral artery bifurcation is thrombendarterectomy (TEA). Endovascular techniques (ENDO) have recently been put forward as a potential alternative. It is unclear so far which modality yields better outcomes with respect to long-term revascularization and periprocedural complications. Method: Multiple databases were systematically searched for pertinent publications (publication date November 1965 to February 2022). From the included studies, individual patient data (IPD) were requested. Aggregate data (AD) were used when no IPD were available. Primary and secondary patency (PP and SP), perioperative morbidity/mortality, and further endpoints were determined separately for TEA and ENDO and compared with each other. AD for each modality were summarized in meta-analyses. Time-to-event analyses and comparative meta-analyses with PP as primary endpoint were carried out using IPD. Results: 42 studies (3 IPD, 39 AD; 27 TEA, 12 ENDO, 3 comparisons of TEA versus ENDO) were included. In the combined meta-analysis of IPD and AD, PP for TEA was 97% at 6 months and 92% at 12 months, while PP for ENDO was 84% at 6 months and 85% at 12 months. The differences were not statistically significant. The comparative meta-analysis regarding PP did not reveal any significant differences either (TEA versus ENDO: HR 0.30 [0.06; 1.48]). SP at 12 months was 97% (TEA) and 93% (ENDO). The periprocedural morbidity was 16% for TEA and 9% for ENDO. Conclusion: In light of a higher PP, even without formal statistical proof of superiority, TEA can still be considered the standard treatment for occlusive processes of the femoral artery bifurcation. METHODS Multiple databases were systematically searched for pertinent publications (publication date November 1965 to February 2022). From the included studies, individual patient data (IPD) were requested. Aggregate data (AD) were used when no IPD were available. Primary and secondary patency (PP and SP), perioperative morbidity/mortality, and further endpoints were determined separately for TEA and ENDO and compared with each other. AD for each modality were summarized in meta-analyses. Time-to-event analyses and comparative meta-analyses with PP as primary endpoint were carried out using IPD. RESULTS 42 studies (3 IPD, 39 AD; 27 TEA, 12 ENDO, 3 comparisons of TEA versus ENDO) were included. In the combined meta-analysis of IPD and AD, PP for TEA was 97% at 6 months and 92% at 12 months, while PP for ENDO was 84% at 6 months and 85% at 12 months. The differences were not statistically significant. The comparative meta-analysis regarding PP did not reveal any significant differences either (TEA versus ENDO: HR 0.30 [0.06; 1.48]). SP at 12 months was 97% (TEA) and 93% (ENDO). The periprocedural morbidity was 16% for TEA and 9% for ENDO. CONCLUSION In light of a higher PP, even without formal statistical proof of superiority, TEA can still be considered the standard treatment for occlusive processes of the femoral artery bifurcation.
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Affiliation(s)
- Carola Marie Hoffmann-Wieker
- *These authors share first authorship.,Department of Vascular and Endovascular Surgery, Heidelberg University Hospital,*Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie Universitätsklinikum Heidelberg Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Ulrich Ronellenfitsch
- *These authors share first authorship.,Department of Visceral, Vascular and Endocrine Surgery, University Medical Center, Martin-Luther-University Halle-Wittenberg (Saale)
| | - Artur Rebelo
- Department of Visceral, Vascular and Endocrine Surgery, University Medical Center, Martin-Luther-University Halle-Wittenberg (Saale)
| | - Nadine Görg
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital
| | - Guido Schwarzer
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, Albert-Ludwigs-University of Freiburg
| | - Enzo Ballotta
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, School of Medicine, Padova, Italy
| | - Yann Gouëffic
- Department of Vascular Surgery, University Hospital of Nantes, France
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital
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Mezzetto L, Mastrorilli D, Scorsone L, Macrì M, Criscenti P, Bruno S, Veraldi E, Veraldi GF. Early and midterm outcomes of hybrid first line treatment in patients with chronic limb threatening ischemia. Vascular 2021; 30:891-901. [PMID: 34416840 DOI: 10.1177/17085381211040986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the outcome of first line hybrid treatment in patients with chronic limb threatening ischemia (CLTI) and to evaluate possible predictors of primary patency (PP) loss and limb clinical improvement (LCI). METHODS This was a retrospective non-randomized study. All patients underwent one-stage hybrid common femoral artery (CFA) endarterectomy combined with an inflow and/or outflow endovascular revascularization procedure. Demographic, clinical, and lesion characteristics for each patient were reported. Primary patency analysis was performed using Kaplan-Meier life tables, and univariate and multivariate analysis was used to assess possible predictors of PP loss and clinical improvement. RESULTS Complete data were obtained from 132 patients. Patients were divided into two groups according to their Rutherford's category (RC), group 1 (Rutherford 4) and group 2 (Rutherford 5 and 6). Technical success was 98%. The overall surgical peri-operative complication rate was 8%. At a mean follow-up of 32 ± 23 months, the rate of major adverse limb events (MALE) was 30%; only the rate of major amputation between two groups was significant statistically different (p = .006). Group 1 had significantly lower amputation rate at 36 months (p = .01). The presence of high iliac peripheral artery calcium scoring system (PACCS) grade (HR 9.43, 95% CI 2.40-36.9, p = .001), the poor run-off of leg vessels (HR 0.15, 95% CI 0.02-0.92, p = .04), and undergoing CFA endarterectomy combined with outflow endovascular revascularization procedure (HR 4.25, 95% CI 1.07-16.89, p = .04) were independent predictors of PP loss, while severe iliac artery stenosis (OR 0.09, 95% CI 0.02-0.32, p = <.001) and the presence of pre-operative patent leg vessels (OR 8.03, 95% CI 2015-29.95, p = .002) were the significant independent predictors of LCI. CONCLUSION The use of hybrid first line approach in patients with CLTI is a safe and feasible technique. From the analysis of the current study, it is clear that any effort should be made to achieve as many patency leg vessels as possible in order to obtain better and longer lasting clinical outcomes.
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Affiliation(s)
- Luca Mezzetto
- Department of vascular surgery, University Hospital and Trust of Verona, University of Verona-School of Medicine, Verona, Italy
| | - Davide Mastrorilli
- Department of vascular surgery, University Hospital and Trust of Verona, University of Verona-School of Medicine, Verona, Italy
| | - Lorenzo Scorsone
- Department of vascular surgery, University Hospital and Trust of Verona, University of Verona-School of Medicine, Verona, Italy
| | - Marco Macrì
- Department of vascular surgery, University Hospital and Trust of Verona, University of Verona-School of Medicine, Verona, Italy
| | - Paolo Criscenti
- Department of vascular surgery, University Hospital and Trust of Verona, University of Verona-School of Medicine, Verona, Italy
| | - Salvatore Bruno
- Department of vascular surgery, University Hospital and Trust of Verona, University of Verona-School of Medicine, Verona, Italy
| | - Edoardo Veraldi
- Department of vascular surgery, University Hospital and Trust of Verona, University of Verona-School of Medicine, Verona, Italy
| | - Gian Franco Veraldi
- Department of vascular surgery, University Hospital and Trust of Verona, University of Verona-School of Medicine, Verona, Italy
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Determinants of Success and Early Complications in Common Femoral Artery Endarterectomy: A Retrospective Study. SURGERIES 2021. [DOI: 10.3390/surgeries2020019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Common femoral artery endarterectomy (CFE) is considered a relatively simple, successful and safe procedure in the literature, but major complications can occur. This retrospective study was performed in order to define characteristics contributing to success or failure after common femoral artery endarterectomy, either performed as a single or hybrid procedure. Methods: A total of 298 patients who underwent CFE in our hospital between 1 January 2011 and 1 January 2017 were included. After exclusion, 227 patients were analyzed. Patient characteristics and outcomes were derived from the patient records. Follow-up was 30 days postoperatively. Outcomes were analyzed by the chi-square test and regression analysis. Clinical success was defined as a combination of technical success, improvement in the ankle-brachial index, increased walking distance and “no complications.” Results: The procedure was clinically successful in 74.4% of the patients, and in 25.6%, a complication occurred. The Rutherford class improved in 65.1% of the patients with 1.6 (SD 1.3) class points. The ankle-brachial index improved in 44.8% of the cases, with an average of 116.6%. The most contributing factors for complications such as death, unplanned amputation, surgical site infection, thrombosis and longer hospital admission were emergency operation and a higher ASA classification. Significantly more complications also occurred in patients with renal failure, congestive heart disease, a high Rutherford classification and previous groin incision. A higher Rutherford class was the only factor correlating with an increase in the ankle-brachial index. When single CFE (48.9% of cases) and hybrid procedures (51.1%) were compared, no significant difference in success or failure was found. Conclusion: Limb ischemia requiring emergency operation and preoperative comorbidity were identified as the most important factors predictive for complications following femoral artery endarterectomy. Combining femoral endarterectomy with an endovascular intervention does not seem to increase the risk of a postoperative complication.
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Woronowicz-Kmiec S, Betz T, Töpel I, Bröckner S, Steinbauer M, Uhl C. Short and long-term outcome after common femoral artery hybrid procedure in patients with intermittent claudication and chronic limb threatening ischemia. VASA 2021; 50:363-371. [PMID: 33973817 DOI: 10.1024/0301-1526/a000954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: This study aimed to evaluate the differences between the outcomes of patients with intermittent claudication (IC) and chronic limb threatening ischemia (CLTI) who underwent a hybrid procedure comprising common femoral artery endarterectomy and endovascular therapy. Patients and methods: This was a retrospective single-center study of all patients with peripheral arterial occlusive disease (PAD) who underwent the hybrid procedure between March 2007 and August 2018. The primary endpoint was primary patency after 7 years. The secondary endpoints were primary-assisted patency, secondary patency, limb salvage, and survival. Results: During the follow-up period, 427 limbs in 409 patients were treated. A total of 267 and 160 patients presented with clinical signs of IC and CLTI, respectively. The 30-day mortality was 1.4% (IC: 0% vs. CLTI: 3.8%, p=0.001). The overall 30-day major amputation rate was 1.6% (IC: 0% vs. CLTI: 4.4, p=0.001). The rates of primary and secondary patency after 7 years were 63% and 94%, respectively, in the IC group and 57% and 88%, respectively, in the CLTI group; the difference was not significant. Limb salvage (94% vs. 82%, p=0.000) and survival (58% vs. 29%, p=0.000) were significantly higher in the IC group. In a multivariate analysis, CLTI was the only risk factor for major amputation. CLTI and single vessel run-off were risk factors for death. Statin therapy was a protective factor. Conclusions: The hybrid procedure provides excellent results as a treatment option for multilevel lesions in patients with PAD. However, patients with CLTI had a shorter long-term survival and lower limb salvage rate.
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Affiliation(s)
| | - Thomas Betz
- Department of Vascular Surgery, Barmherzige Brüder Hospital Regensburg, Germany
| | - Ingolf Töpel
- Department of Vascular Surgery, Barmherzige Brüder Hospital Regensburg, Germany
| | - Stefan Bröckner
- Department of Vascular Surgery, Barmherzige Brüder Hospital Regensburg, Germany
| | - Markus Steinbauer
- Department of Vascular Surgery, Barmherzige Brüder Hospital Regensburg, Germany
| | - Christian Uhl
- Department of Vascular Surgery, Barmherzige Brüder Hospital Regensburg, Germany
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Ricco JB, Saucy F. Hybrid Surgery in Patients With CLTI. A Stimulating Report From Egypt. Eur J Vasc Endovasc Surg 2020; 59:956. [PMID: 32234271 DOI: 10.1016/j.ejvs.2020.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/05/2020] [Indexed: 10/24/2022]
Affiliation(s)
- J-B Ricco
- Department of Clinical Research and Innovation (DRCI), University Hospital of Poitiers, Poitiers, France.
| | - F Saucy
- Department of Vascular Surgery, Ensemble Hospitalier de la Côte, Morges, Switzerland
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