Systematic review of endovascular intervention and surgery for common femoral artery atherosclerotic disease

Abstract

Background Endovascular intervention has emerged as a potential alternative to open surgery in treating common femoral artery (CFA) atherosclerotic disease. The aim of this systematic review was to assess the safety and efficacy of both techniques. Methods Thirteen electronic databases from 1980 to 3 January 2018 were searched. Study quality was assessed using the National Institute for Health and Care Excellence Interventional Procedure Programme quality assessment tool. Safety and efficacy outcome measures were analysed. Results Thirty‐one studies reporting 813 endovascular procedures and 3835 endarterectomies were included. Only two small RCTs have been reported. The methodological quality of available studies was generally low and follow‐up short. Safety endpoint assessment revealed a similar risk of wound haematoma for endovascular intervention and endarterectomy (5·5 (95 per cent c.i. 0·2 to 17·2) versus 3·9 (1·7 to 6·9) per cent respectively), a lower risk of wound infection with endovascular procedures (0 versus 5·9 (3·4 to 9·0) per cent) and a lower risk of wound lymph leakage (0 versus 5·7 (3·3 to 8·6) per cent). Efficacy endpoint assessment at 1 year identified that endovascular intervention had a lower primary patency rate than endarterectomy (78·8 (73·3 to 83·8) versus 96·0 (92·2 to 98·6) per cent respectively), a higher revascularization rate (16·0 (6·1 to 29·4) versus 5·8 (1·0 to 14·2) per cent) and a similar amputation rate (2·7 (1·2 to 4·8) versus 1·9 (0·7 to 3·8) per cent). Conclusion Endovascular intervention of CFA disease appears to reduce the risk of wound complications but is associated with a lower patency rate and increased rates of subsequent revascularization procedures. Standardization of the endovascular technique and quantification of the proportions of patients suitable for either technique are required.

Hybrid Revascularization for Extensive Iliofemoral Occlusive Disease

“…Classically occlusions affecting the common femoral artery (CFA) were considered not suitable for a purely endovascular approach due anatomical challenges, stenting of this area has high risk of in-stent restenosis or secondary thrombosis of the deep femoral artery. (1,2) Recent reports on endovascular treatment are optimistic, however when it comes to thrombosis of the femoral bifurcation, open approach is in most vascular centers the rule since it provides longer patency (3,4). Hybrid procedures combining simultaneous femoral endarterectomy and endovascular recanalization of the occluded iliac arteries offer an alternative approach.…”

Safety and feasibility study of non-invasive robot-assisted high-intensity focused ultrasound therapy for the treatment of atherosclerotic plaques in the femoral artery: protocol for a pilot study

“…Another concern is that stent placement in this region may limit access options for future procedures, and the bending forces may cause stent fracture and subsequent arterial occlusion. 12 For this reason, despite the risk of infection and septic bleeding, open endarterectomy of the CFA is still considered the gold-standard therapy. 13 14 …”

“…Despite the reduction of wound-related complications and shorter hospital stay, endovascular revascularisation in the CFA is associated with a lower patency and increased rates of subsequent revascularisation procedures. Another concern is that stent placement in this region may limit access options for future procedures, and the bending forces may cause stent fracture and subsequent arterial occlusion 12. For this reason, despite the risk of infection and septic bleeding, open endarterectomy of the CFA is still considered the gold-standard therapy 13 14…”

Study of endovascular treatment in obstructive aortoiliac lesions: Immediate and short-term results

“…For such lesions, the traditional recommendation is open surgical procedure (bypass graft) (6) with a patency rate of 87.5% and 81.8% at 5 and 10 years, but with mortality and morbidity rate of 3.3% and 8.3% respectively (7). However, use of endovascular treatment for such lesions is not uncommon as many patients who need the intervention do not meet the criteria for surgery (8). The aim of present study was to evaluate aorto-iliac occlusive disease using different diagnosis modalities like duplex ultrasound, CT angiography and invasive peripheral angiography and to describe short-term outcome of endovascular treatment for such lesions.…”