Morbidity and mortality of common femoral endarterectomy

Authors

Michael Chaney, Western Michigan University Homer Stryker, Kalamazoo, MI.
Gaurang Joshi, Advocate Health - Midwest
Jose Cataneo Serrato, Advocate Health - MidwestFollow
Mohammed Rashid, Advocate Health - MidwestFollow
Abraham Jacobs, Advocate Health - Midwest
Chad E. Jacobs, Advocate Health - MidwestFollow
John V. White, Advocate Health - MidwestFollow
Lewis B. Schwartz, Advocate Health - MidwestFollow
Rym El Khoury, Department of Surgery, Division of Vascular Surgery, NorthShore University Health Systems, Evanston, IL. Electronic address: rymelkhoury@gmail.com.

Recommended Citation

Chaney M, Joshi G, Serrato JC, et al. Morbidity and mortality of common femoral endarterectomy. J Vasc Surg. Published online February 13, 2024. doi:10.1016/j.jvs.2024.01.211

Affiliations

Advocate Lutheran General Hospital

Abstract

Objective:Common femoral endarterectomy (CFE) comprises the current standard-of-care for symptomatic common femoral artery (CFA) occlusive disease. While it provides effective inflow revascularization via a single incision, it remains an invasive procedure in an often-frail patient population. The purpose of this retrospective clinical study was to assess the morbidity and mortality of CFE in a contemporary cohort.

Methods:Consecutive CFEs performed at a large, urban hospital were reviewed. 6-month mortality, local (hematoma, lymphatic leak, pseudoaneurysm, wound infection and/or dehiscence), and systemic complications were analyzed using univariate and multivariate analyses.

Results:129 isolated CFEs were performed over 7 years for claudication (36%), rest pain (16%), tissue loss (29%), or acute on chronic limb ischemia (21%). Mean age was 75±9 years and 68% of patients were male. Comorbidities were prevalent including coronary artery disease (54%), diabetes (41%), chronic pulmonary disease (25%), and congestive heart failure (22%). The majority of CFEs were performed under general anesthesia (98%) with patch angioplasty using bovine pericardium (73% vs. 27% Dacron). Twenty-two patients (17%) sustained local complications following the procedure; their occurrence was significantly associated with obesity (p=0.002) but no technical or operative factors. Nineteen patients (15%) sustained serious systemic complications; their occurrence was significantly associated with CLTI (p<0.001), and a high ASA class (p=0.002). By 6-months, 17 patients (13%) had died. Being on dialysis, presenting with CLTI, and being in a high ASA class at the time of operation were all associated with 6-month mortality; a high ASA class at the time of operation was independently predictive of mortality (OR=3.08 [1.03-9.24]; p=0.044).

Conclusions:Although commonly performed, CFE is not a benign vascular procedure. Disease presentation, anesthetic risk and expected longevity play an important role in clinical outcomes. Evolving endovascular approaches to the CFA could serve to reduce morbidity and mortality in the future.

Type

Article

PubMed ID

38360191