Technique and results of femoral bifurcation endarterectomy by eversion

Dufranc, Julie; Palcău, Laura; Heyndrickx, Maxime; Gouicem, Djelloul; Coffin, Olivier; Felisaz, Aurélien; Berger, L.

doi:10.1016/j.jvs.2014.09.025

Cited by 23 publications

(18 citation statements)

References 17 publications

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“…The reason for this is that most of these cases involved lesions of the bifurcation of the CFA, a pattern that is not rare. 17 This region meets the conditions for high local stress, such as those that are present at the carotid bifurcation or at the aortic bifurcation: a greater cross section, bending effects, reduced thickness and opposite curvatures. 5 The femoral bifurcation is therefore considered to be a vulnerable site where an isolated stenosis of the DFA rarely occurs.…”

Section: Discussionmentioning

confidence: 79%

Retrospective angiographic study to determine the effect of atherosclerotic stenoses of upstream arteries on the degree of atherosclerosis in distal vascular territories

et al. 2016

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ObjectiveExperimental coarctation of the aorta prevents the development of downstream atherosclerosis. The aim of this study was to find out whether or not atherosclerotic stenoses protect distal vascular territories from developing atherosclerosis in humans.Design and settingA total of 2125 vascular segments from angiographies of 101 patients were evaluated by calculating the maximum degree of stenosis (NASCET criteria), the degree of calcification, the degree of collaterals and the Friesinger score.ResultsStenosis ≥30–49% was found in 685 vascular segments (32.2%), ≥50–69% in 490 (23.1%), ≥70–89% in 373 (17.6%) and ≥90% in 265 (12.5%). If a stenosis of at least ≥70–89% was present in the common iliac, the external iliac or the common femoral artery, the degrees of stenosis distal to it were lower than those on the contralateral side (19.8±22.3% (CI 11.7 to 28.0) vs 25.2±20.7% (CI 21.2 to 29.1); Friesinger scores 1.1±1.2 (CI 0.6 to 1.5) vs 1.4±1.1 (CI 1.2 to 1.6); degrees of calcification 0.8±1.0 (CI 0.4 to 1.1) vs 1.2±1.1 (CI 1.2 to 1.6); p<0.05 each). This effect depended on the degree of proximal stenosis, but not on collaterals, and was most pronounced distal to stenoses of the common iliac, the superficial femoral and the popliteal artery. In regression models, stenoses of the pelvic arteries were shown to be an independent protective factor for the distal vascular territories.ConclusionsAtherosclerotic stenoses seem to protect distal vascular territories from developing atherosclerosis. The underlying pathophysiological mechanism of this phenomenon remains to be determined. It could be based on pulse pressure reduction.

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Section: Discussionmentioning

confidence: 79%

Retrospective angiographic study to determine the effect of atherosclerotic stenoses of upstream arteries on the degree of atherosclerosis in distal vascular territories

et al. 2016

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“…An overall success rate of 92.52% (95% CI [89.08%, 94.94%]) was noted ( Figure 2 A). However, in the FAE group, 10 studies [ 6 , 7 , 13 , 14 , 20 , 22 , 23 , 24 , 25 , 26 ] reported the technical success rates, and an overall success rate of 97.02% (95% CI [93.39%, 98.69%]) ( Figure 2 B) was observed. The odds ratio calculated was 0.38 (95% CI [0.27–0.54], p < 0.001), thus favouring the FAE group significantly.…”

Section: Resultsmentioning

confidence: 99%

“…Symptom improvement was reported in 9 case series [ 8 , 9 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ] for ET procedures, while under FAE treatment, 1 RCT [ 6 ] and 5 case series [ 5 , 23 , 24 , 25 , 26 ] commented on symptom improvement. For ET procedures, the overall rate of symptom improvement was 83.10% (95% CI [73.67%, 89.63%]) ( Figure 4 A).…”

Section: Resultsmentioning

confidence: 99%

Comparative Analysis of Endovascular Intervention and Endarterectomy in Patients with Femoral Artery Disease: A Systematic Review and Meta-Analysis

et al. 2022

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Peripheral artery disease is a prevalent illness affecting more than 200 million people worldwide. A commonly used technique to manage the condition has been open endarterectomy. However, in recent times, a shift towards minimally invasive techniques has resulted in endovascular intervention as a popular alternative. This review aims to assess the safety and efficacy of endovascular intervention when compared with endarterectomy. A systematic review of the articles published in PubMed, Ovid, Embase, and Scopus within the last 10 years was conducted. The PRISMA guidelines were adhered to, and the Newcastle-Ottawa and NICE quality assessment scales were used. A meta-analysis of proportions was performed using the RStudio software (RStudio Team (2021). RStudio: Integrated Development Environment for R, PBC, Boston, MA, USA). Twenty-six studies were included, with a total of 7126 patients (endovascular, 2496; endarterectomy, 4630). Technical success was greater for endarterectomy than endovascular intervention with an odds ratio of 0.38; 95% CI [0.27–0.54]. In terms of safety as well endovascular intervention was better than endarterectomy with an odds ratio of 0.22; 95% CI [0.15 to 0.31] for wound infection. Endovascular intervention is a safe and effective procedure; however, it cannot be considered superior to endarterectomy.

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“…Endarterectomy remains the gold standard technique to approach the femoral bifurcation. 10 The recent Global Vascular Guidelines (GVG) on the Management of Chronic Limb-Threatening Ischemia recommend endarterectomy as the optimal approach to treat CFA disease 13 and report a fiveyear primary patency rate between 82.5% and 96%. 2,3,14 Our experience with EE was comparable to the classical technique obtaining a primary patency rate of 87.5% at one year, with no wound infections or pseudoaneurysms during follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…7 Although it remains a valuable solution for the carotid bifurcation, 8,9 this technique is now less frequently used in the iliofemoral territory, with a few authors reporting their results. 10,11 The aim of this study is to present our experience implementing the eversion femoral endarterectomy technique in selected cases of common femoral occlusive disease.…”

Section: Introductionmentioning

confidence: 99%

A single-center experience in the eversion femoral endarterectomy

et al. 2020

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Objectives Endarterectomy is the treatment of choice for arterial occlusive disease of the femoral bifurcation. Longitudinal arteriotomy and prosthetic patch angioplasty is the standard technique but, due to the increasing concerns with prosthetic-related infections and multidrug-resistant pathogens our group adopted an alternative approach. We present our experience with eversion femoral endarterectomy. Methods All patients submitted to eversion femoral endarterectomy in a single institution during 2016–2019 were retrospectively analyzed. Patient demographics, surgical data, and complications were captured from medical records. Results Nineteen patients, 84.2% male and a median age of 67 years (IQR 62–78) were submitted to eversion femoral endarterectomy with a median follow-up of 180 days (IQR 71–395). Seventeen (89.4%) patients were treated for chronic limb ischemia and the other two were submitted to femoral endarterectomy during endovascular aortic aneurysm repair. Most of the patients had smoking history (84.2%), followed by hypertension (68.4%), dyslipidemia (63.2%), coronary heart disease (29.4%), and diabetes (26.3%). Only 3 patients (15.8%) were submitted exclusively to endarterectomy, 13 (68.4%) were submitted to endarterectomy as an adjuvant for peripheral endovascular treatment, 2 (10.5%) as a concomitant procedure to endovascular repair of aortic aneurysm, and 1 (5.3%) was complemented with thrombectomy of the femoro-popliteal sector. Primary patency rates were 100% and 87.5% (CI (38.7–98.1)) at 6 and 12 months, respectively. Primary-assisted and secondary patency rates were 100%. The 30-day mortality rate was 5.3% ( n = 1) and complication rate 10.5% ( n = 2). One patient complicated with acute renal disease related to rhabdomyolysis. Another patient developed a wound-related hematoma treated with surgical drainage, but died three days after consequent to ischemia-reperfusion injury. Conclusions Eversion femoral endarterectomy is a safe and feasible technique, with good patency results and respecting the concept of leaving nothing behind. A careful control of the proximal and distal endpoints is essential for the success of the technique.

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Technique and results of femoral bifurcation endarterectomy by eversion

Cited by 23 publications

References 17 publications

Retrospective angiographic study to determine the effect of atherosclerotic stenoses of upstream arteries on the degree of atherosclerosis in distal vascular territories

Retrospective angiographic study to determine the effect of atherosclerotic stenoses of upstream arteries on the degree of atherosclerosis in distal vascular territories

Comparative Analysis of Endovascular Intervention and Endarterectomy in Patients with Femoral Artery Disease: A Systematic Review and Meta-Analysis

A single-center experience in the eversion femoral endarterectomy

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