Abstract

Objective To investigate the efficacy and safety of combined common femoral artery (CFA) endarterectomy with superficial femoral artery (SFA) stenting in patients with complex multifocal arterial steno-obstructive lesions of the lower extremities.Methods From March 2006 to May 2010,92 lower limbs in 86 patients with multilevel peripheral arterial steno-occlusive disease,involving SFA as well as CFA and profunda femoris artery (PFA) orifice,were treated by combined open surgery with endovascular therapy,such as SFA stenting as an adjunct to CFA endarterectomy and patch angioplasty with the great saphenous vein.During follow-up,clinical status assessment,ankle-brachial index (ABI) test,and duplex Doppler ultrasound were administered every 6 months,and computed tomography angiography (CTA) or digital subtraction angiography (DSA) was performed at 12,24 and 36 months after discharge.Results Procedures were successful in all patients.Average ABI increased from 0.31 ± 0.24 to 0.82 ± 0.36 (P =0.000).There was no perioperative death and major limb amputations.The mean duration of follow-up was 1 486 ± 472 days (range,1 010-2 064 days).During follow-up,4 patients died of myocardial or cerebral infarction or pneumonia,and 4 were lost to follow-up.There were 18 cases (19.6％) of restenosis,with 14 in-stent and 4 near the distal end of the stent.Reinterventions were performed in 12 cases,including 4 balloon angioplasty,5 restenting,1 bypass and 2 major limb amputations.The primary patency rates were 90.2％,74.6％ and 58.4％ at 12,24,and 36 months,respectively,while the secondary patency rates were 92.7％、80.8％ and 70.2％ at 12,24,and 36 months,respectively.Conclusions Combined CFA endarterectomy with SFA stenting offer a safe,less invasive and effective treatment to patients with chronic lower extremity ischemia due to complex multifocal peripheral artery disease. Key words: Arteriosclerosis obliterans ; Endarterectomy ; Angioplasty ; Stents

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