56. Description and Outcomes of A Simple Surgical Procedure To Treat the Failing Forearm Arteriovenous Fistula

Abstract

Introduction and Objectives: Atherosclerotic disease of common femoral and profunda femoris arteries (CFA/PFA) has been historically treated with surgical endarterectomy. Endovascular treatment of CFA and PFA disease has been reported in the recent literature. This review describes current endovascular treatments to the CFA and PFA. Methods: An electronic PubMed database search of all reports of CFA and PFA endovascular treatments in the English language was performed. Relevant studies were retrieved and analyzed. Results: Analysis of 19 studies was performed totaling 721 patients with a mean age of 70.5 years. Indications for treatment include claudication in 51.8%, critical limb ischemia in 45.5% and other in 2.8%. Technical success occurred in 96% of procedures with CFA treatment in 44% and PFA in 56% of cases. Angioplasty alone occurred in 69.4% of cases, stenting in 26% and thrombolysis or atherectomy in 4.6%. Mean ankle-brachial index increased by 0.23 following intervention. Access complications and groin hematomas occurred in 3.1% of cases; distal embolization in 1.3%. Mean peri-operative mortality was 0.27% with all-cause mortality of 15% over a mean follow-up period of 21 months. Mean primary patency was 79% at a mean follow-up of 12 months with secondary patency of 87.5% at a mean follow-up of 33 months. Routine stenting of the CFA or PFA led to a mean primary patency of 85.9% at a mean follow-up of 18 months. Endarterectomy or surgical bypass was undertaken in 8.8% of patients during the follow-up period, endovascular re-intervention occurred in 5.9% and major amputation in 2.7%. Conclusions: Endovascular interventions to the CFA and PFA can be performed safely and with high technical success. Mid-term patency when routine stenting is applied is comparable to surgical endarterectomy. Primary endovascular therapy may be a favored approach for high surgical risk patients given the low rate of procedural-related mortality and morbidity.