A recent study suggests that endovascular treatment of the common femoral artery (CFA) is associated with an increased rate of long-term CFA-specific reintervention, regardless of indication. Nicholas Wells, MA, a medical student at Yale School of Medicine in New Haven, Connecticut, presented this and other key findings from a tertiary care center analysis of open and endovascular treatment of the CFA during yesterday’s William J. von Liebig Forum at VAM 2024.
“The CFA is a common site of disease in patients with peripheral arterial disease,” Wells began. He noted that endarterectomy is seen as the gold standard of treatment, with primary patency rates “often surpassing 95% at five years” and evidence of “excellent long-term durability as far out as eight years.”
The objective of the study, Wells shared, was to compare open and endovascular treatment of the CFA with a focus on reinterventions and major adverse limb events.
This was a retrospective study of all revascularizations involving the CFA, including repeated reinterventions, conducted at a single center between 2013 and 2020. “These procedures were performed by various specialists, including vascular surgeons, interventional radiologists and interventional cardiologists,” Wells detailed, adding that the researchers used standard comparative statistics and stratified their analysis by indication—claudication versus chronic limb-threatening ischemia (CLTI).
The researchers found that, from their database of 1,954 patients, 23% were treated for the CFA at least once and 15% of all individual revascularizations involved the CFA.
“Patients with claudication were more likely to be treated initially with endovascular therapy, at 57%, and those with CLTI were more likely to be treated with open surgery, at 60%,” Wells added.
The presenter reported that approximately one-third of the open surgery group underwent extended CFA endarterectomy involving the external iliac arteries, superficial femoral artery, and profunda femoral arteries, and about one-third underwent a concomitant ipsilateral bypass.
He also noted that approximately half of the patients in the endovascular group underwent concomitant endovascular revascularization of the distal femoropopliteal region.
In the perioperative period, Wells shared that open surgery was associated with an increased rate of bleeding and wound infection, while endovascular therapy was associated with shorter mean length of hospital stay. Perioperative major amputation and mortality were below 1% in both groups.
“For claudication, endovascular therapy led to an increased rate of CFA-specific reintervention in the long term—35% compared to just 21% of those initially treated with open surgery,” Wells revealed.
“Additionally,” he continued, “15% of those who initially received endovascular treatment required eventual conversion to endarterectomy of the CFA, while only 5% of those who were initially treated with open surgery required a redo open CFA with endarterectomy.”
The researchers observed similar outcomes in the CLTI group, where 33% of initial endovascular recipients required eventual CFA reintervention compared to 21% of those initially treated with open surgery. Conversion to endarterectomy was not found to be significant in this subgroup.
“The take-home message here was that endovascular therapy led to higher rates of CFA reintervention in the long term and that for claudicants, conversion to endarterectomy was more common following endovascular therapy than redo endarterectomy,” the presenter told VAM attendees.
After a median follow-up time of three to four years, major amputation, major adverse limb events and mortality were not found to be different.
Furthermore, major adverse limb events-free survival—which was defined as time to either reintervention to any artery, major amputation or death—was not found to be significantly different between treatment approaches in either subgroup.
Senior author Cassius Iyad Ochoa Chaar, MD, told Vascular Specialist@VAM that the anatomy of the CFA is “very peculiar,” and that the extent of the disease treated was not accounted for in this analysis. “Our future work will focus on studying the anatomy of the atherosclerosis affecting the CFA to better understand which lesions are best treated with which strategy of revascularization,” he commented.
