Eversion Endarterectomy of the Femoral Bifurcation: Technique and Results

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Objectives: To evaluate, in a prospective and monocentric series, the results of eversion endarterectomy of the femoral tripod. Materials and Methods: Between 2010 and 2012, we included 121 consecutive patients (mean age 68.7 years, 76% men, 28% diabetics, 20% with renal insufficiency) among whom we carried out 147 eversion endarterectomies of the femoral tripod (EEFT), sometimes associated with an upstream or downstream revascularization other than a bypass. Surgical indication was claudication in 89 cases (60%) and critical ischemia in 58 cases (40%). The studied criteria were patency, clinical improvement, and limb salvage (survival curves according to Kaplan-Meier and univariate analyzes in the search of risk factors of degradation). Results: The technical success of eversion was of 93.2%. Mortality at 30 days was null. The rate of complications was 8.2%. Half of these complications were local and benign. The median follow-up was 16 months (1.631.2 months). The two years primary, assisted primary, and secondary patency rates were 93.2%, 97.2%, and 98.6%, respectively. Primary, assisted primary, and secondary clinical improvement rates at two years were 79.9%, 94.6%, and 98.6%, respectively. The risk factors of clinical degradation were a Rutherford clinical stage 5 or 6 (p1⁄40.024), antiplatelet treatment (APT) without clopidogrel (p1⁄40.005), malnutrition (p1⁄40.025), and a poor downstream arterial network (p1⁄40.0016). A reintervention was necessary in 22% of the treated limbs within two years: 2.7% of recurrences in the femoral tripod, 6.1% of additional upstream revascularizations, 9.5% of downstream revascularizations, and 5.4% of major amputations. The limb salvage at two years was 100% in the claudicants, and 88.6% in the event of critical ischemia. The risk factors were the malnutrition (p1⁄40.029), BMI 450 G/L (p1⁄40.0071), APT without clopidogrel (p1⁄40.022), preoperative deep femoral stenosis >75% (p1⁄40.0064), and a poor limb downstream network (p1⁄40.00042). Conclusion: EEFT is reliable, effective and reproducible for the treatment of atheromatous lesions of the femoral tripod. Moreover, the eversion does not use a patch for