PC160 Common Femoral Artery Endarterectomy: Contemporary Results Using Eversion Endarterectomy vs Standard Endarterectomy With Patch

Abstract

For over 50 years, standard endarterectomy with patch (SEP) of the common femoral artery (CFA) has been well described with durable results. Eversion endarterectomy (EE) uses a complete CFA transection above its bifurcation and subsequent end-to-end anastomosis. EE is potentially advantageous over SEP by avoiding prosthetic patch infection and easing future transfemoral access. With subjectively more focal femoral artery lesions encountered during the endovascular era, we reviewed our SEP and EE outcomes to see whether there were any differences between the two methods. We retrospectively identified all patients undergoing CFA endarterectomy by a single surgeon who adopted preferential EE at a single institution between 2007 and 2015. Patient demographics and surgical details were captured from the electronic medical record, including endarterectomy type and the performance of concurrent endovascular and/or bypass surgery. Complications and adverse events were recorded. Statistical comparison of means was performed using the t-test, and categoric variables were evaluated using the Fisher exact test. Eighty-nine sequentially encountered patients underwent 97 endarterectomies of the CFA (68 SEP and 29 EE). More SEP than EE cases were performed concomitant with either bypass or stenting (62% vs 34%). Most patients were smokers (80% of SEP vs 93% of EE). Patients undergoing EE were older (67 vs 62 years; P = .01), with less hypertension (59% vs 79%; P = .04), and less chronic kidney disease (4% vs 27%; P = .01). The observed frequencies of diabetes, dyslipidemia, coronary artery disease, stroke, coagulopathy, and cancer were not significantly different among EE and SEP patients. The average follow-up duration was 28 months, longer among SEPs patients than EE patients (32 vs 20 months; P = .02). We observed favorable primary patency with EE (Table). There were no statistically significant differences observed among adverse events associated with SEP and EE patients (Fig): CFA restenoses (10% vs 3.4%), CFA thromboses (12% vs 0%), and wound infections (10% vs 7%). EE and SEP both offer reasonably durable outcomes for the treatment of focal femoral arterial occlusive disease. EE may offer an attractive alternative to SEP, potentially decreasing the risk of significant wound complications associated with prosthetic patch infections.TablePrimary patencyProcedureNo.Duration in months6% (n/N)12% (n/N)18% (n/N)24% (n/N)30% (n/N)36% (n/N)42% (n/N)EE All29100 (17/17)100 (16/16)100 (15/15)100 (12/12)100 (9/9)100 (7/7)100 (5/5) Alone19100 (10/10)100 (9/9)100 (8/8)100 (6/6)100 (4/4)100 (4/4)100 (1/1)SEP All6886 (49/57)77.6 (38/49)76 (34/45)74 (32/43)67.6 (23/34)60.7 (17/28)52 (12/23) Alone2685.7 (18/21)81 (12/16)78.6 (11/14)78.6 (11/14)70 (7/10)57 (4/7)57 (4/7)All, All cases; Alone, cases without concurrent operations; EE, eversion endarterectomy; SEP, standard endarterectomy with patch. Open table in a new tab