Common femoral artery endarterectomy in the age of endovascular therapy

Objectives: Common femoral artery endarterectomy (CFE) is the standard treatment for common femoral artery occlusive disease. We aim to assess the medium term outcomes of CFE with or without further concomitant procedures. Design: A retrospective observational study. Methods: All patients who underwent either isolated CFE (ICFE), CFE with angioplasty for occlusive arterial disease (CFEA) or concomitant CFE with endovascular aortic aneurysm repair (CFEE) were included. Patient demographics follow up, clinical improvement, types of CFE closure, patency rates, and survival-free amputation were noted. Results: From 2002 to 2015, 1512 patients were referred with a diagnosis of critical limb ischemia. Of those, 1134 required revascularization. Sixty-one patients underwent 66 CFE. Ten limbs underwent an ICFE, 35 had CFEA, and 21 underwent CFEE. Demographics were comparable in all groups. Twenty-seven were closed primarily, while 39 required patch closure (12 venous, 8 Dacron, 19 biological). Technical success was 100% in ICFEs, 94% in CFEA, and 100% for CFEE (p = 0.274). Immediate clinical success was 100% in both CFE and CFEE, but was 85.7% in CFEA (p = 0.035). Immediate hemodynamic success was similar in all three groups (p = 0.73). Sustained hemodynamic success was 30% in ICFE, 54.3% in CFEA, and 23.8% in CFEE (p = 0.056). At two years, the primary patency was 90% in ICFE, 74.3% in CFEA, and 100% in CFEE (p = 0.049). Primary-assisted patency was 90% in ICFE, 82.9% in CFEA, and 100% in CFEE (p = 0.17). Secondary patency was 90% in ICFE, 94.3% in CFEA, and 100% in CFEE (p = 0.409). Re-intervention was required in 26.9% of primary closures, versus 12.8% with patch closures (p = 0.279). Amputation-free survival was 100% in ICFE, 80% in CFEA, and 100% in CFEE (p = 0.056). Conclusion: CFE is a reliable and dependable procedure, even in the absence of good distal runoff.