The natural history of isolated common femoral endarterectomy for chronic limb-threatening ischemia

Authors

Michael Chaney, Western Michigan University Homer Stryker, Kalamazoo, MI.
Gaurang Joshi, Advocate Health - Midwest
Jose L. 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 System, Evanston, IL. Electronic address: rymelkhoury@gmail.com.

Recommended Citation

Chaney M, Joshi G, Cataneo Serrato JL, et al. The natural history of isolated common femoral endarterectomy for chronic limb-threatening ischemia. J Vasc Surg. Published online May 30, 2024. doi:10.1016/j.jvs.2024.05.050

Affiliations

Advocate Lutheran General Hospital

Abstract

Objective:Occlusive disease of the common femoral artery can generate profound lower extremity ischemia as the normal collateral pathways from the profunda to the superficial femoral artery cannot adequately develop. In patients with lifestyle-limiting claudication, isolated endarterectomy of the common femoral artery (CFE) is highly effective. As CFE does not provide direct, in-line flow to the plantar arch, it has been felt to provide inadequate revascularization to patients with chronic limb-threatening ischemia (CLTI). The purpose of this retrospective clinical study was to report and assess the natural history of selected patients with CLTI treated with isolated CFE (without concomitant infrainguinal revascularization).

Methods:Consecutive CFE performed in a large, urban hospital for CLTI between 2014-2021 were reviewed. Patient characteristics, limb, and anatomic stages using the Wound, Ischemia, foot Infection (WIfI) and Global Anatomic Staging Systems (GLASS) were tabulated. Limb-specific and survival-related endpoints were analyzed.

Results:58 patients presenting with CLTI underwent isolated CFE (mean age 74±10 years; 62% male, 90% current or prior smoker). Comorbidities included diabetes (52%), coronary artery disease (55%), congestive heart failure (22%), and end-stage renal failure on hemodialysis (5%). Patients presented with either rest pain (36%) or tissue loss (64%); the latter group exhibited advanced limb threat (68% in WIfI stage 3 or 4). The majority of patients had associated severe infrainguinal disease (50% GLASS 3). After a median follow-up of 17 months (range 10-29 months), vascular reintervention was required in 7 patients (12%). One patient (2%) required major limb amputation after presentation in WIfI stage 4 (W3I3fI0). Indeed, WIfI stage 4 was a significant univariate predictor of the need for subsequent infrainguinal bypass (p=0.034).

Conclusions:Isolated CFE as primary therapy in highly selected patients with CLTI was safe and effective. Index limb stage is predictive of the need for associated infrainguinal revascularization in this complex population.

Type

Article

PubMed ID

38823529