Tracking Endovascular Treatment of the Femoral Arteries

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Dr. Jeffrey Siracuse will report on the study he and his colleagues performed to analyze practice patterns and outcomes from endovascular treatment of the common femoral (CFA) and deep femoral arteries (DFA). The Vascular Quality Initiative (2010-2015) was queried for all endovascular interventions on the CFA and DFA. They identified 3,960 endovascular CFA/DFA interventions; 1296 (nearly 33%) were isolated to the CFA/DFA. The average age of this isolated cohort was 68 years and 59% were men.

Indications for treatment were claudication (62%), rest pain (18%), and tissue loss (19%). Stents and atherectomy were used in about 28% and 18% of cases, respectively. The intervention was a technical success in nearly 92% of cases.

Dr. Jeffrey M. Siracuse

Dr. Jeffrey M. Siracuse

Perioperative complications included embolization, perforation, access hematoma, and dissection.

They found that thirty-day mortality was 1.6%, with survival of 93% and 87% at 1 and 3 years.

Dr. Siracuse, from the Boston University School of Medicine, will detail their results showing that the significant predictors of mortality were end-stage renal disease (hazard ratio [HR], 3.21, tissue loss, HR, 2.59), combined CFA/DFA intervention (HR, 1.88), chronic obstructive pulmonary disease (HR, 1.73), and nonambulatory status (HR, 1.61).

Freedom from loss of patency/death was 83% at 1 year, according to the researchers. Predictors of patency loss/death were tissue loss (HR, 2.67) and nonambulatory status (HR, 2.17). Freedom from reintervention/death was 83%. Signficant predictors of reintervention or death were tissue loss (HR, 3.52),and stenting (HR, 1.73); with P2Y12 antagonists (HR, 0.62) being signficantly protective.

Amputation-free survival at 1 year was 92%. Significant predictors of amputation/death were tissue loss (HR, 18.9), rest pain (HR, 5.47), previous major amputation (HR, 4.02), and stenting (HR, 2.83), with aspirin use (HR, 0.42) and P2Y12 antagonists (HR, 0.25) being protective.

“Endovascular interventions of the CFA/DFA have a low rate of perioperative morbidity and mortality. One-year patency is lower than historical controls of CFA endarterectomy. Stent use is associated with reinterventions and amputation and should be avoided if possible. Longer-term analysis is needed to better assess durability,” Dr. Siracuse concluded.

VON LIEBIG FORUM
8:30 – 10:00 a.m. Thursday
Potomac Ballroom A/B

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