Femoral Artery Occlusive Disease Research Articles

Treatment of TASC II D SFA Occlusive Disease Using A Novel Percutaneous Bypass Procedure: Results from the PQ Bypass Detour I Trial

Introduction - Patients with lower extremity ischemia due to long segment superficial femoral artery (SFA) occlusive disease do not have an optimal treatment solution today. Percutaneous endovascular revascularization lacks durability in these long segments while surgical bypass, the current gold-standard for durability, is associated with greater morbidity, longer length of stay and longer recovery times. Percutaneous femoral popliteal bypass (PQB) is an emerging treatment option that combines the safety and minimally invasive benefits of a percutaneous procedure with the long-term durability of surgical bypass. This trial evaluates the safety and effectiveness of the PQ Bypass System to treat long-segment SFA occlusions via a fully percutaneous bypass utilizing the femoral vein as a partial conduit. Methods - This is a prospective, multi-center, non-randomized, single-arm trial. Primary 6-month safety endpoint: Major Adverse Events (MAE); defined as death, target vessel revascularization and major amputation of the target limb. Primary performance endpoint: primary patency at 6 months; defined as Peak Systolic Velocity Ration (PSVR) of less than or equal to 2.5. A proprietary crossing device and proprietary snare are used to create anastamoses between the artery and vein at the proximal and distal margins of the SFA occlusion. A series of proprietary stent grafts are then deployed in continuous overlapping fashion to create an SFA to popliteal artery bypass, resulting in a large lumen endograft bypass that delivers unobstructed pulsatile flow to the popliteal artery. Results - 60 subjects have been enrolled in the Primary Analysis Cohort and 60 treated. Mean age was 64 ± 9 years (68/68), 83.3% (50/60) of patients were male. The PQ Bypass System successfully delivered guidewires and placed stent grafts and thus completed a percutaneous fem-pop bypass in 98.3% (59/60) of cases. Independent Core Lab-assessed screening CTAs indicate a mean lesion length of 28.6 ± 5.1 (60/60), with 96.7% (58/60) considered to be chronic total occlusion and 33.3% (20/60) having previous peripheral artery revascularization or surgery. At 6 months, the primary safety and efficacy endpoints were met, respectively, at 3.4% MAE with 0 cases of DVT and 84.7% primary patency. 91.2% of subjects experienced at least a 2 class improvement in Rutherford Class at 6 months. Conclusion - For patients with SFA occlusive disease, percutaneous bypass with the PQ Bypass System using the femoral vein as a conduit may prove to be an important step forward in providing an optimal treatment solution.

Directional Atherectomy of the Common Femoral Artery. Learning Curve and One Year Follow up

Introduction: The use of Directional Atherectomy (DA) with or without anti-restenotic therapy (ART) may be considered for the management of common femoral artery (CFA) occlusive disease because of its minimally invasive nature with early mobilisation, reduced incision complications and infection rates [1-5]. However, it has recognised complications, which may be related to the learning curve. We present our initial experience using DA and suggest changes that may, based on our practice, improve outcomes. Methods: A consecutive series of patients who underwent CFA DA +/- ART for chronic limb ischemia with > 70 % CFA stenosis in two tertiary hospitals between June 2017 and December 2018 are described here. All of them had Ultrasound (USS) and /or Computerised Tomography Angiogram (CTA) before the procedure. Data were collected prospectively and retrospectively evaluated. The primary endpoints were technical success (< 50% residual stenosis in the CFA measured by USS after the procedure), primary patency of the CFA measured by USS at 1, 3, 6 and 12 months and also morbidity and mortality. Secondary endpoints were change in Rutherford-Becker class, target lesion revascularisation rate and length of stay post-procedure. Patients were selected for DA by the treating surgeon based on IFU and significant comorbidities. CFA DA was performed in isolation or in conjunction with other endovascular treatment of the iliac/ipsilateral femoral or tibial vessels Results: Between July 2017 and December 2018, 25 patients underwent CFA DA. Two had an occluded CFA and 23 had >70% CFA stenosis as determined by USS [6, 7] and CTA preop. There were no deaths within 30 days. Procedure-related complications included 2 cases of CFA pseudoaneurysm (one of them repaired by open surgery) (Figure 1 and Figure 2) and 1 CFA perforation (repaired with covered stent). No distal embolisation or limb loss occurred. The mean length of stay was: 1.96 days. The primary and secondary patency at 3 and 6 months was 100%. At 12 months it was 96%. Conclusion: Early results suggest that CFA DA ± ART is safe & effective and may be advantageous over open endarterectomy in some patients. However preoperative imaging or intravascular USS (IVUS) may be required to ensure that the device passes are in areas of highest plaque burden to avoid early complications and localised dilatation over time.Figure 2A: Pre DA. B: Post CFA DA + EIA Viabahn. C: Duplex USS 6 month later. D: 6 months later.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Disclosure: Nothing to disclose

Optimizing decision-making strategies in managing superficial femoral artery occlusive disease

Optimizing decision-making strategies in managing superficial femoral artery occlusive disease

Management of Common Femoral Artery Occlusive Disease: A Review of Endovascular Treatment Strategies and Outcomes

Isolated atherosclerotic lesions of the common femoral artery (CFA) are rare but can produce significant claudication and critical limb ischemia. To date, the treatment for this entity has been common femoral endarterectomy (CFE) with or without patch angioplasty. However, surgery does have significant early postoperative complications, with a 15% combined mortality/morbidity. This manuscript sought to perform a comprehensive review of all studies and available data on endovascular treatment of isolated CFA disease and compare its utility to the traditional gold standard treatment. Twenty-one studies from 1987 to 2018 were included exploring the various CFA endovascular therapies (percutaneous transluminal angioplasty, intravascular stenting, drug-coated balloons, and directional atherectomy employed to treat CFA disease, in terms of efficacy, safety, and complications). As a conclusion, endovascular interventions provide acceptable short-term technical outcomes for CFA disease while limiting procedural complications. While only two randomized controlled trials compare short and long-term outcomes of surgical versus endovascular treatment, further studies are required to clarify the role of endovascular therapy.

Lumen Gain After Endovascular Therapy in Calcified Superficial Femoral Artery Occlusive Disease Assessed by Intravascular Ultrasound (CODE Study)

Purpose: To assess calcium patterns in superficial femoral artery (SFA) disease before and after balloon angioplasty ± stent implantation using fluoroscopy, angiography, and intravascular ultrasound (IVUS) imaging and then correlate calcification severity and midterm clinical outcomes. Materials and Methods: A multicenter investigation was carried out to retrospectively review 130 symptomatic patients (mean age 73.2±8.4 years; 86 men) with de novo SFA lesions who had successfully undergone endovascular therapy (EVT) at 7 centers between January and October 2015. The primary outcome was lumen gain measured as minimum lumen area (MLA) in post-EVT IVUS images according to calcification severity. The secondary outcomes included rates of stent malapposition, restenosis, and clinically-driven target lesion revascularization (TLR). Results: A total of 102 (78.5%) cases had calcification in the lesions over a mean length of 64.3±72.8 mm. Of these, 70 cases were classified as having bilateral calcification according to fluoroscopy and angiography; 50 (49%) lesions had ≥180° calcification according to IVUS. The lumen gain in calcified lesions was significantly smaller than in the 28 noncalcified lesions (14.1±4.4 vs 17.8±5.2 mm2, p<0.001). IVUS-evaluated circumferential distribution of calcium (<180° or ≥180°) was independently associated with lumen gain after EVT (p<0.001). Among the calcification characteristics, a calcification angle ≥180° showed the strongest correlation to postprocedure MLA. Moreover, the restenosis rate was significantly higher in the severe (≥180°) calcification group (p<0.018). The severity of calcification was also associated with the risk of stent malapposition (p=0.022 for trend) but not TLR (p=0.57). Conclusion: IVUS evaluation of calcification in SFA lesions predicted lumen gain after EVT. Severe calcification in a ≥180° arc prevented successful dilation of the lesion with either plain balloon angioplasty or a nitinol stent. Accurate assessment of calcification patterns by IVUS is useful in maximizing the efficacy of endovascular therapy.

Endovascular intervention in flush superficial femoral artery occlusive disease: challenges and outcome

Endovascular intervention in flush superficial femoral artery occlusive disease: challenges and outcome

Better treatment option in chronic superficial femoral artery occlusive disease: comparison of methods (meta-analysis).

Introduction: The objective is to evaluate the frequency of primary obstruction events (PrO) during one-year follow-up after performing excisional atherectomy with the SilverHawk/TurboHawk atherectomy device (S/TH) or remote superficial femoral artery endarterectomy (RSFAE) in patients with the chronic superficial femoral artery occlusive disease (СSFAOD). Methods: We included all randomized clinical trials (RCTs) and not-RCTs concerning the treatment of patients with СSFAOD after S/TH and RSFAE without duration. Results: Twenty-nine items (1990-2017) were discovered; 27 articles on the levels of evidence were included in qualitative synthesis; 9 studies (meta-analysis) were included in quantitative synthesis. The results of 2762 patients’ treatment were summed up in our analysis (1422 patients S/TH; 1340 patients RSFAE). All included reports were at low risk of bias. According to the criterion "frequency of PrO" during one-year follow-up, the pooled Hazard Ratios indicate significant favours of S/TH if compared it with RSFAE (HR= 0.66 (0.57 to 0.76, P < 0.00001), I2 = 9%). Conclusion: Our study showed that S/TH with the SpiderFX device (distal embolic protection) are safe and effective treatment option for short lesion (<15 cm) in patients with СSFAOD. The usage of S/TH methods significantly reduced number of PrO if compared it with RSFAE. In long-segment lesion (>15 cm) in patients with СSFAOD, RSFAE may be considered better than an endovascular procedure. But still it is necessary to conduct well-planned randomized studies to determine effectiveness and safety of the compared methods (S/TH and RSFAE) in patients with long-segment lesion (>15 cm).

Management of common femoral artery occlusive disease: A review of endovascular treatment strategies and outcomes.

Isolated atherosclerotic lesions of the common femoral artery (CFA) are rare but can produce significant claudication and critical limb ischemia. To date, the "gold standard" treatment for this entity has been common femoral endarterectomy (CFE) with or without patch angioplasty. However, surgery does have significant early postoperative complications, with a 15% combined mortality/morbidity. This manuscript sought to perform a comprehensive review of all studies and available data on endovascular treatment of isolated CFA disease and compare its utility to the traditional gold standard treatment. Twenty-one studies from 1987 to 2018 were included exploring the various CFA endovascular therapies (percutaneous transluminal angioplasty, intravascular stenting, drug-coated balloons, and directional atherectomy employed to treat CFA disease, in terms of efficacy, safety, and complications). As a conclusion, endovascular interventions provide acceptable short-term technical outcomes for CFA disease while limiting procedural complications. While only two randomized controlled trials compare short and long-term outcomes of surgical versus endovascular treatment, further studies are required to clarify the role of endovascular therapy.

Outcome of drug-eluting balloon angioplasty versus endarterectomy in common femoral artery occlusive disease

ObjectiveCommon femoral artery (CFA) occlusive disease remains a debatable site for endovascular therapy, and the outcome of drug-eluting balloon (DEB) angioplasty in treating CFA occlusive disease is largely unknown. This study compared the efficacy, safety, and short-term patency rate of DEB angioplasty and femoral endarterectomy for treatment of CFA occlusive disease. MethodsFrom March 2013 to June 2016, there were 100 patients with symptomatic CFA occlusive disease who were retrospectively reviewed. Forty patients were treated with DEB angioplasty and 60 were treated with femoral endarterectomy. Each patient received regular follow-up. Patency rate, ankle-brachial index, target lesion revascularization, and adverse events were assessed. ResultsTechnical success was 100% in all patients. The DEB group had a lower 1-year primary patency rate (75.0% vs 96.7%; P = .003), but the secondary patency rate was similar between the two groups (97.5% vs 98.3%; P = 1.000). At 2-year follow-up, the primary patency was lower in the DEB group (57.1%) than in the endarterectomy group (94.1%; P = .001), whereas the secondary patency rate had no significant difference (90.5% vs 97.1%; P = 1.000). Both groups had significant improvement in ankle-brachial index. Freedom from target lesion revascularization was lower in the DEB group both at 1 year (75.0% vs 96.7%; P = .003) and at 2 years (57.1% vs 94.1%; P = .001). There was no significant difference in the incidence of complications and adverse events. ConclusionsFemoral endarterectomy has a better primary patency rate compared with DEB angioplasty in treating CFA occlusive disease without significant increase in complications. In patients not suitable for endarterectomy, DEB angioplasty provides a similar secondary patency rate and could be considered an alternative treatment.

Common femoral artery endarterectomy in the age of endovascular therapy.

Common femoral artery endarterectomy (CFE) is the standard treatment for common femoral artery occlusive disease. We aim to assess the medium term outcomes of CFE with or without further concomitant procedures. A retrospective observational study. All patients who underwent either isolated CFE (ICFE), CFE with angioplasty for occlusive arterial disease (CFEA) or concomitant CFE with endovascular aortic aneurysm repair (CFEE) were included. Patient demographics follow up, clinical improvement, types of CFE closure, patency rates, and survival-free amputation were noted. From 2002 to 2015, 1512 patients were referred with a diagnosis of critical limb ischemia. Of those, 1134 required revascularization. Sixty-one patients underwent 66 CFE. Ten limbs underwent an ICFE, 35 had CFEA, and 21 underwent CFEE. Demographics were comparable in all groups. Twenty-seven were closed primarily, while 39 required patch closure (12 venous, 8 Dacron, 19 biological). Technical success was 100% in ICFEs, 94% in CFEA, and 100% for CFEE ( p = 0.274). Immediate clinical success was 100% in both CFE and CFEE, but was 85.7% in CFEA ( p = 0.035). Immediate hemodynamic success was similar in all three groups ( p = 0.73). Sustained hemodynamic success was 30% in ICFE, 54.3% in CFEA, and 23.8% in CFEE ( p = 0.056). At two years, the primary patency was 90% in ICFE, 74.3% in CFEA, and 100% in CFEE ( p = 0.049). Primary-assisted patency was 90% in ICFE, 82.9% in CFEA, and 100% in CFEE ( p = 0.17). Secondary patency was 90% in ICFE, 94.3% in CFEA, and 100% in CFEE ( p = 0.409). Re-intervention was required in 26.9% of primary closures, versus 12.8% with patch closures ( p = 0.279). Amputation-free survival was 100% in ICFE, 80% in CFEA, and 100% in CFEE ( p = 0.056). CFE is a reliable and dependable procedure, even in the absence of good distal runoff.

Edge Stenosis After Covered Stenting for Long Superficial Femoral Artery Occlusive Disease: Risk Factor Analysis and Prevention With Drug-Coated Balloon Angioplasty

Purpose: To report a retrospective analysis of risk factors for edge restenosis after Viabahn stent-graft treatment of superficial femoral artery (SFA) occlusive disease and determine any protective effect of drug-coated balloons (DCBs) used at the time of stent-graft implantation. Methods: Between October 2011 and July 2016, 110 patients (mean age 73.3±7.6 years; 78 men) were treated with the Viabahn stent-graft for long SFA occlusions. Thirty-eight (34.5%) patients had DCB reinforcement at the distal edge of the stent-graft. For analysis, the population was divided into groups of no edge stenosis patients (n=88; mean lesion length 22.4±4.2 cm) and edge stenosis patients (n=22; mean lesion length 23.5±5.7 cm). The clinical outcomes, ankle-brachial indices, computed tomography angiography findings, and patency were compared at a minimum of 12 months. Logistic regression analysis was employed to determine risk factors for edge stenosis; the results are presented as the odds ratio (OR) and 95% confidence interval. Results: No differences in clinical or procedural characteristics were identified except the higher incidence of diabetes (p=0.008) and greater need for retrograde access (p=0.033) in the edge stenosis group. DCB reinforcement reduced the incidence of edge stenosis (p=0.021) and target lesion revascularization (TLR; p=0.010) and resulted in a significantly higher 1-year primary patency rate (92.1% vs 76.4%, p=0.042). However, multivariate analysis revealed only poor distal runoff (OR 0.31, 95% CI 0.11 to 0.83, p=0.020) as a predictor of edge stenosis. Conclusion: The risk of edge stenosis after Viabahn implantation was higher in patients with poor distal runoff. DCB reinforcement over the distal edge reduced edge stenosis, decreased 1-year TLR, and improved 1-year primary patency.

Post-operative Outcomes Following above Knee Amputation in Patients with Occluded Common Femoral Arteries

Above knee amputation (AKA) represents a significantly morbid procedure in patients with end stage peripheral artery disease. Complications and mortality are significant in this cohort. This study seeks to determine the role of common femoral artery (CFA) occlusive disease in complications after above knee amputation.

Real-World Comparison of Drug-Eluting and Bare-Metal Stents in Superficial Femoral Artery Occlusive Disease with Trans-Atlantic Intersociety Consensus B Lesions: A 2-Year, Single-Institute Study.

Endovascular stenting has surpassed bypass surgery to become the first-line treatment for superficial femoral artery (SFA) occlusive disease, and various types of stents including bare-metal stents (BMSs), covered stents, and drug-eluting stents (DESs), have been approved for treatment. This retrospective, single-institute study compared the short-term, real-world outcomes of BMSs and DESs for treating SFA occlusive disease. A retrospective chart review was used to enroll 94 patients who received a DES (n = 24) or BMS (n = 70) between 2009 and 2014. All patients had SFA occlusive disease with critical limb ischemia and an intermediate length of SFA occlusion [Trans-Atlantic Intersociety Consensus (TASC)-II B lesions] and were regularly followed for 2 years. All patient characteristics, procedural details, and outcomes were recorded. The 1-year primary patency rates in the BMS and DES groups were 71.4% and 87.5% (p = 0.169), respectively, and the corresponding 2-year rates were 61.4% and 79.2% (p = 0.139). The target lesion revascularization rate was 38.6% versus 20.8% (p = 0.139), the in-stent restenosis rate was 22.9% versus 0% (p = 0.009), the major limb amputation rate was 4.3% versus 0% (p = 0.568), the peripheral arterial disease-related mortality rate was 8.6% versus 0% (p = 0.332), and the all-cause mortality rate was 11.4% versus 0% (p = 0.109), respectively. The 2-year results revealed higher safety, superior efficacy, and greater clinical benefits of DESs than BMSs for treating TASC-II B SFA occlusive disease. However, more cases and long-term follow-up are warranted.

Directional Atherectomy Is Associated with Better Long-Term Efficiency Compared with Angioplasty for Common Femoral Artery Occlusive Disease in Rutherford 2–4 Patients

Despite increased interest in treating common femoral artery (CFA) with endovascular technology, there are little data regarding the long-term outcomes of different endovascular treatment modalities. We report the results after endovascular therapy of symptomatic obstructions of the CFA in a single center. We retrospectively reviewed the records of consecutive patients with eligible CFA lesions who were treated with endovascular methods between 2011 and 2013. The preoperative demographic operative details and postoperative outcomes were compared and statistically analyzed. Ninety patients with CFA lesions were treated, and 76 (84.4%) completed a follow-up. Claudication was present in 62 of 76 (81.6%) patients, and stenosis was present in 60 of 76 (78.9%) patients. Angioplasty was performed in 45 patients, and atherectomy was performed in 31 patients. There was no significant difference in the preoperative demographic data, procedure time, contrast administration, or length of hospital stay between the 2 groups. In-hospital treatment costs were significantly higher in the atherectomy group (69,822 RenMinBi Yuan vs. 49,078 RenMinBi Yuan; P=0.043). During the 4-year primary patency, for whole group or bifurcated/claudicant subgroup, all patients within the atherectomy group were significantly better than those in the angioplasty group. Atherectomy may be a better alternative to angioplasty for CFA atherosclerotic obstructions lesions. Compared with angioplasty, atherectomy seems to have better results in bifurcated lesions or claudicant patients. In diabetic patients, no superiority was found on either patency or improvement in walking distance.

Abstract No. 662 Endovascular revascularization of challenging superficial femoral artery occlusive disease in critical limb ischemia

Abstract No. 662 Endovascular revascularization of challenging superficial femoral artery occlusive disease in critical limb ischemia

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

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

Percutaneous common femoral artery interventions using angioplasty, atherectomy, and stenting

This study evaluated the feasibility, safety, and effectiveness of endovascular interventions for common femoral artery (CFA) occlusive disease. Using a prospectively maintained multicenter database, we analyzed outcomes in 167 consecutive patients who underwent percutaneous CFA interventions for Rutherford class 3 to class 6 (R3-R6) disease. The standardized treatment approach included primary percutaneous transluminal angioplasty (PTA) only, atherectomy+ PTA, and provisional stenting. Outcomes included technical failure rate, recurrence, complications, and major or minor amputation rate. Data were analyzed using multivariate regression analysis. During a 7-year period, 167 patients with R3 (n= 91 [54.5%]) and R4 to R6 (n= 76 [45.5%]) disease underwent CFA interventions that included PTA only (n= 114 [68.2%]), atherectomy± PTA (n= 38 [22.8%]), and provisional stenting (n= 15 [9.0%]) for failed atherectomy± PTA. Procedure-related complications included pseudoaneurysm (n= 1 [0.6%]), thrombosis (n= 1 [0.6%]), distal embolization (n= 1 [0.6%]), and death (R6, n= 1 [0.06%]). CFA restenosis was observed in 34 (20.4%) patents; these underwent further percutaneous (n= 18 [10.8%]) or surgical (n= 17 [10.2%]) revascularization that included CFA endarterectomy± femoral distal bypass. Major or minor amputations were observed in none of the R3 patients and in only three (3.9%) and five (6.5%) of the R4 to R6 patients, respectively. Compared with the atherectomy+ PTA group, patients in the PTA-only group had a significantly lower patency. Furthermore, during long-term mean follow-up of 42.5months, the CFA provisional stent group had a 100% primary patency, which was significantly better than the primary patency in the CFA nonstent groups combined (77.0%; P= .0424). Data from this study to date would suggest that percutaneous CFA interventions in select patients are relatively safe and effective. In the long term, CFA stenting has significantly better primary patency than CFA atherectomy and PTA combined. CFA atherectomy+ PTA has significantly better primary patency than CFA PTA-only atmidterm, especially in patients with claudication. Future randomized controlled trials are warranted.

Efficacy of iliac inflow repair in patients with concomitant iliac and superficial femoral artery occlusive disease

In multilevel arterial disease, whether complete revascularization or staged runoff repair should be performed remains controversial. The aim of this study was to evaluate the efficacy of iliac inflow repair and to identify clinical conditions that are associated with the need for runoff repair in concomitant iliac and superficial femoral artery (SFA) occlusive disease. Patients undergoing inflow repair for complicated flow-limiting iliac lesions with diffuse SFA disease between 2007 and 2013 were retrospectively reviewed. Patients with poor response to inflow repair underwent infrainguinal revascularization (IIR). The 29 ischemic limbs examined in this study represent 26 different patients (22 males; mean age, 77±8years). Indications for inflow repair were Rutherford Classifications III (31%), IV (31%), V (31%), and VI (7%). Severity of the complicated SFA disease was either TASC (TransAtlantic Inter-Society Consensus) type C (14%) or type D (86%). Overall, freedom from IIR was 90% after 30days and 83% after 1year. Patients having claudication, rest pain, and shallow ischemic ulcers experienced the relief of symptoms, whereas patients with deep gangrene that needed minor amputation required IIR more frequently (p<0.01). Anatomical risk factors for poor response to inflow repair were poor quality of the deep femoral artery (p<0.01) and the flow-limiting popliteal artery (p=0.02), and poor below-knee runoff (≤ 1 vessel, p<0.01). Iliac inflow repair can reverse the symptoms in patients with multilevel arterial occlusive disease that are not associated with gangrenous toes.

Surgical Treatment of Stent Restenosis after Long Segment Placement into the Superficial Femoral Artery

Endovascular stent placement is taking place of the bypass surgery in patients with peripheral arterial disease, over the last decade. However, patency of the long segment stents, below knee disease, advenced age, absence of distal runoff, diabetes and chronic renal disease are still challenging. Surgical bypass for the superficial femoral artery occlusive disease to the below the knee stenosis by using autologous vein graft has still good results. Here we present a 55 year old male who had long segment superficial femoral artery atherosclerotic disease. He had a history of long segment endovascular stent placement. We extracted the restenotic stent and performed bypass with PTFE graft to the below the knee.

Clinical Outcome of Surgical Endarterectomy for Common Femoral Artery Occlusive Disease.

Although common femoral artery endarterectomy (CFE) is the standard treatment for occlusive disease of the common femoral artery (CFA), several studies have noted encouraging results for endovascular therapy in this anatomical area. A retrospective multi-center study of 118 consecutive limbs from 111 symptomatic patients undergoing CFE between April 1998 and December 2014 was performed. Seventy-five CFE were performed on limbs for intermittent claudication and 43 CFE were performed for critical limb ischemia (CLI). The prevalence of perioperative complications was higher in patients with CLI than in the claudication patients. The technical success rate was 99% in all cases. The 1- and 5-year primary patency rates were 100% and 100% for claudication and 95% and 95% for CLI, respectively. The assisted-primary patency rates were 100% at both time points in both groups. Freedom from major amputation at 1 and 5 years was 100% and 100% in the claudication patients and 93% and 82% in the CLI patients, respectively. The 1- and 5-year overall survival rates were 97% and 89% in the claudication patients and 69% and 33% in the CLI patients, respectively. CFE is a safe, effective and durable procedure for occlusive disease of the CFA. This procedure should remain the standard treatment for this anatomical region.