Common femoral artery endarterectomy in the age of endovascular therapy

Elsherif, Mohamed; Tawfick, Wael; El-Sharkawi, Mohamed E.; Campell, R; Hynes, Niamh; Sultan, Sherif

doi:10.1177/1708538118772682

Cited by 16 publications

(8 citation statements)

References 29 publications

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“…These efficacy findings align with published studies of femoral endarterectomy with patch angioplasty, which have reported 1-year and long-term patency rates of 90-100% and 85-96%, respectively (78)(79)(80)(81)(82). However, limited prospective evidence has been published comparing outcomes of SIS-ECM with different types of patches for femoral endarterectomy.…”

Section: Sis-ecm In Iliofemoral Artery Reconstruction-perform Studysupporting

confidence: 85%

Extracellular Matrix Patches for Endarterectomy Repair

Allen

Adams

Badylak

et al. 2021

Front. Cardiovasc. Med.

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Patch repair is the preferred method for arteriotomy closure following femoral or carotid endarterectomy. Choosing among available patch options remains a clinical challenge, as current evidence suggests roughly comparable outcomes between autologous grafts and synthetic and biologic materials. Biologic patches have potential advantages over other materials, including reduced risk for infection, mitigation of an excessive foreign body response, and the potential to remodel into healthy, vascularized tissue. Here we review the use of decellularized extracellular matrix (ECM) for cardiovascular applications, particularly endarterectomy repair, and the capacity of these materials to remodel into native, site-appropriate tissues. Also presented are data from two post-market observational studies of patients undergoing iliofemoral and carotid endarterectomy patch repair as well as one histologic case report in a challenging iliofemoral endarterectomy repair, all with the use of small intestine submucosa (SIS)-ECM. In alignment with previously reported studies, high patency was maintained, and adverse event rates were comparable to previously reported rates of patch angioplasty. Histologic analysis from one case identified constructive remodeling of the SIS-ECM, consistent with the histologic characteristics of the endarterectomized vessel. These clinical and histologic results align with the biologic potential described in the academic ECM literature. To our knowledge, this is the first histologic demonstration of SIS-ECM remodeling into site-appropriate vascular tissues following endarterectomy. Together, these findings support the safety and efficacy of SIS-ECM for patch repair of femoral and carotid arteriotomy.

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Section: Sis-ecm In Iliofemoral Artery Reconstruction-perform Studysupporting

confidence: 85%

Extracellular Matrix Patches for Endarterectomy Repair

Allen

Adams

Badylak

et al. 2021

Front. Cardiovasc. Med.

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“…Management of CFA lesions is challenging. Surgical treatment and endarterectomy of CFA lesions has been proved to be safe and reliable procedure [1][2][3][4]. Elsherif et al [4] has reported the outcome of 1134 revascularization procedures due to critical limb ischemia, out of which 66 CFA endarterectomies with favorable outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical treatment and endarterectomy of CFA lesions has been proved to be safe and reliable procedure [1][2][3][4]. Elsherif et al [4] has reported the outcome of 1134 revascularization procedures due to critical limb ischemia, out of which 66 CFA endarterectomies with favorable outcome. However, improvement in endovascular procedures in recent years, has resulted in numerous publications showing good results of endovascular treatment of CFA lesions [5][6][7][8][9][10].…”

Section: Discussionmentioning

confidence: 99%

“…Common femoral artery (CFA) chronic total occlusion (CTO) represents a true challenge even for experienced and skilled interventional radiologist. In case of extensive, complex and long occlusive lesions of CFA and iliac arteries, surgical treatment is still preferable treatment option [1][2][3][4]. However, progress of endovascular therapy as less invasive procedure in the last two decades, have resulted in numerous publications showing good results of endovascular treatment of CFA stenosis and occlusion with low rate of post-procedural morbidity and mortality [5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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Antegrade dissection of external iliac artery after failed attempt of common femoral artery chronic total occlusion angioplasty

et al. 2022

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Introduction. Endovascular treatment of chronic total occlusion (CTO) represents a true challenge even for experienced interventional radiologists. We are presenting a case of hidden antegrade dissection of external iliac artery (EIA) after failed attempt to recanalize CTO of common femoral artery (CFA). Case outline. Fifty-two-year-old male patient was admitted for multidetector computed tomography angiography. Left common iliac artery (CIA) stenting was performed followed by ?crossover? attempt of recanalization of right CFA CTO that failed. The next day, left femoral superficial artery angioplasty was performed and after one month, angioplasty of the left popliteal and bellow knee arteries. A month later the patient was readmitted for surgical reconstruction of the CFA. After desobstruction, excellent inflow was obtained and Dacron graft inserted. A few hours postoperatively, Fogarty catheter thrombectomy was performed. The next morning pulsations were weakened again and CT angiography showed antegrade dissection of the EIA. Stenting of the EIA was performed with two stents and favourable outcome. After detailed analysis of CT, hidden thrombosed antegrade dissection of EIA was noted in lateral view, that was not seen in posterior/anterior view and was presented as fibrous plaque with mural thrombosis. Dissection occurred after failed attempt of CFA recanalization and was clinically silent until flow was established triggering opening of the false lumen and release of thrombotic masses. Conclusion. In patients with failed angioplasty of chronic total occlusion of CFA and CT characteristics of fibrous plaque proximal of the site of attempted angioplasty, thrombosed antegrade dissection should be thought of.

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“…Common femoral artery endarterectomy (CFAe) is a well-established therapy to treat peripheral artery disease. Previous studies have demonstrated good shortterm and mid-term patency rates (1)(2)(3)(4)(5)(6)(7)(8). However, long-term results have been infrequently published.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Outcome of Common Femoral Artery Endarterectomy In Octogenarians and Non-Octogenarians

et al. 2020

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Objective: Arteriosclerotic disease of the common femoral artery can be treated by surgical or endovascular intervention. Elderly patients are said to have a worse outcome if treated by surgical means; however, data to support this theory are missing. Methods: Retrospective analysis of all patients who underwent common femoral artery endarterectomy between March 2007 and July 2018 in our clinic. Group 1 included all patients <80 years and Group 2 included all patients ⩾80 years. Endpoints were patency rates, limb salvage, and overall survival. Results: During this time period, 977 common femoral artery endarterectomies were performed. Indication was claudication in 61.5% and critical limb ischemia in 38.5%. Group 1 included 805 cases (82.4%) and Group 2 included 172 cases (17.6%). Thirty-day mortality was 2.7% (Group 1 = 1.6% versus Group 2 = 7.6%; p < 0.001) and 30-day major amputation was 1.1% (Group 1 = 0.7% versus Group 2 = 2.9%; p = .043). Primary patency and secondary patency were 84.2% and 96.8%, respectively, after 7 years. Limb salvage (93.7%, Group 1 = 94.1% versus Group 2 = 91.8%; p = .088) and overall survival (52.0%, Group 1 = 59.1% versus Group 2 = 15.7%; p = .006) were significantly different after the same time period. Multivariable analysis showed female gender to be a risk factor for loss of primary patency. Age ⩾ 80 years and ulcer or gangrene were risk factors for death. Statin use was beneficial to survival. Conclusion: Common femoral artery endarterectomy is a safe procedure with excellent long-term results. Octogenarians have an increased risk for perioperative mortality and major amputation.

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Common femoral artery endarterectomy in the age of endovascular therapy

Abstract: CFE is a reliable and dependable procedure, even in the absence of good distal runoff.

Cited by 16 publications

References 29 publications

Extracellular Matrix Patches for Endarterectomy Repair

Extracellular Matrix Patches for Endarterectomy Repair

Antegrade dissection of external iliac artery after failed attempt of common femoral artery chronic total occlusion angioplasty

Long-Term Outcome of Common Femoral Artery Endarterectomy In Octogenarians and Non-Octogenarians

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