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Abstract

Thank you for your interest in our article1Kang J.L. Patel V.I. Conrad M.F. Lamuraglia G.M. Chung T.K. Cambria R.P. Common femoral artery occlusive disease: contemporary results following surgical endarterectomy.J Vasc Surg. 2008; 48: 872-877Abstract Full Text Full Text PDF PubMed Scopus (141) Google Scholar and below is our response to your comments.1A variety of anesthetic choices are available for common femoral artery (CFA) endarterectomy. Some 40% in our series were performed with general anesthesia; if there are genuine reasons to avoid it, spinal or local anesthesia can be used.2In response to the type of patch used for common femoral artery endarterectomy (CFE), we do not routinely use vein patch for CFE. In fact, the majority of CFEs included in this study were performed using Dacron (59%), polytetrafluoroethylene (PTFE; 23%), or bovine pericardium (15%). There was only one deep infection requiring re-exploration and removal of patch. We disagree that surgeons are reluctant to use Dacron patches on the CFA. In fact, it is rather standard practice in the United States.3In response to the comment that CFE offers no great advantage in performing concomitant endovascular procedures, we disagree. The sheath, placed through the center of the patch, can easily be manipulated to treat an inflow and/or outflow disease and the comment about creating a stenosis when suturing the sheath puncture site is just plain silly.4Lastly, we would like to reiterate our stand that we believe most lesions in the CFA are best treated via surgical endarterectomy. While some patients may have limited, focal disease of the CFA allowing for a short stent placement to treat their lesions,2Stricker H. Jacomella V. Stent-assisted angioplasty at the level of the common femoral artery bifurcation: midterm outcomes.J Endovasc Ther. 2004; 11: 281-286Crossref PubMed Scopus (67) Google Scholar most patients with disease in the CFA have extensive, bulky, calcified plaques that are best treated with open surgical approach. While the authors are “in no doubt” about the value of CFA stenting, there is no evidence base to support their conviction. Common femoral artery occlusive disease: Contemporary results following surgical endarterectomyJournal of Vascular SurgeryVol. 48Issue 4PreviewProliferation of endovascular techniques with perceived reduction in treatment morbidity repetitively question the precept that surgical endarterectomy is the preferred treatment for occlusive disease of the common femoral artery (CFA). This study details a contemporary experience with common femoral endarterectomy (CFE) with and without concomitantly performed endovascular therapies. Full-Text PDF Open ArchiveRegarding “Common femoral artery occlusive disease: Contemporary results following surgical endarterectomy”Journal of Vascular SurgeryVol. 49Issue 4PreviewWe read with interest the article by Kang et al.1 We congratulate the authors on their impressive series and agree that the operation of common femoral endarterectomy (CFE) offers an excellent treatment for many patients and that this report may serve as a standard for comparison with emerging endovascular therapies. However, we disagree with their statement that the low morbidity associated with CFE negates any presumed advantage of endovascular therapy. Full-Text PDF Open Archive