Long-term results of combined common femoral endarterectomy and iliac stenting/stent grafting for occlusive disease

• Published in: Journal of vascular surgery 2008-08, Vol.48 (2), p.362-367
• Main Authors: Chang, Robert W., MD, Goodney, Philip P., MD, Baek, Jennie H., BS, Nolan, Brian W., MD, Rzucidlo, Eva M., MD, Powell, Richard J., MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Analysis of Variance; Angiography, Digital Subtraction - methods; Arterial Occlusive Diseases - diagnostic imaging; Arterial Occlusive Diseases - mortality; Arterial Occlusive Diseases - surgery; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Catheterization - methods; Cohort Studies; Combined Modality Therapy; Endarterectomy - methods; Female; Femoral Artery - surgery; Follow-Up Studies; Graft Survival; Humans; Iliac Artery; Intermittent Claudication - diagnosis; Intermittent Claudication - surgery; Kaplan-Meier Estimate; Logistic Models; Male; Medical sciences; Middle Aged; Multivariate Analysis; Retrospective Studies; Risk Assessment; Severity of Illness Index; Stents; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival Analysis; Treatment Outcome; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2008.03.042

Background Common femoral artery (CFA) endarterectomy with iliac stenting or stent grafting can be an alternative to traditional open surgery in patients with aortoiliac occlusive disease. We report the long-term outcomes of this approach. Methods Patients undergoing CFA endarterectomy with simultaneous iliac stenting/stent grafting between 1997 and 2006 were retrospectively reviewed. Technical success, clinical and hemodynamic outcomes, and 5-year patency using life-table methodology were determined. Factors associated with reintervention and mortality were determined by logistic regression analysis. Results A total of 171 patients (mean age, 67 ± 10 years; 38% female; 35% diabetic) underwent 193 CFA endarterectomies and iliac stent/stent grafting. Indications were rest pain (32%), tissue loss (22%), and claudication (46%). External iliac artery (EIA) lesions were present in 39%, and combined common iliac artery (CIA) and EIA lesions were seen in 61% of patients. Complete CIA/EIA occlusions were present in 41% of patients. Stent grafts were used in 41% of patients. Technical success occurred in 98% of patients. Clinical improvement was seen in 92% of patients. Mean ankle-brachial index increased from 0.38 ± 0.32 to 0.72 ± 0.24. Median length of stay was 2 days (range, 1-51 days). Thirty-day mortality was 2.3% and 5-year survival was 60%. Five-year primary, primary-assisted, and secondary patencies were 60%, 97%, and 98% respectively. Endovascular reintervention was required in 14% of patients; inflow surgical procedures were required in 10%. By logistic regression analysis, use of stent grafts compared with bare stents was associated with significantly higher primary patency (87% ± 5% vs 53% ± 7%; P < .01). Conclusion Combined CFA endarterectomy with iliac intervention yield acceptable long-term results. The use of stent grafts compared with bare stents is associated with improved primary patency.