scholarly journals Determinants of Success and Early Complications in Common Femoral Artery Endarterectomy: A Retrospective Study

Surgeries ◽  
2021 ◽  
Vol 2 (2) ◽  
pp. 180-189
Author(s):  
Marcel Libertus Johannes Quax ◽  
Daniël Eefting ◽  
Herman Joseph Smeets
Keyword(s):  
Retrospective Study ◽  
Femoral Artery ◽  
Clinical Success ◽  
Ankle Brachial Index ◽  
Emergency Operation ◽  
Common Femoral Artery ◽  
Walking Distance ◽  
Safe Procedure ◽  
Hybrid Procedures ◽  
Significant Difference

Introduction: Common femoral artery endarterectomy (CFE) is considered a relatively simple, successful and safe procedure in the literature, but major complications can occur. This retrospective study was performed in order to define characteristics contributing to success or failure after common femoral artery endarterectomy, either performed as a single or hybrid procedure. Methods: A total of 298 patients who underwent CFE in our hospital between 1 January 2011 and 1 January 2017 were included. After exclusion, 227 patients were analyzed. Patient characteristics and outcomes were derived from the patient records. Follow-up was 30 days postoperatively. Outcomes were analyzed by the chi-square test and regression analysis. Clinical success was defined as a combination of technical success, improvement in the ankle-brachial index, increased walking distance and “no complications.” Results: The procedure was clinically successful in 74.4% of the patients, and in 25.6%, a complication occurred. The Rutherford class improved in 65.1% of the patients with 1.6 (SD 1.3) class points. The ankle-brachial index improved in 44.8% of the cases, with an average of 116.6%. The most contributing factors for complications such as death, unplanned amputation, surgical site infection, thrombosis and longer hospital admission were emergency operation and a higher ASA classification. Significantly more complications also occurred in patients with renal failure, congestive heart disease, a high Rutherford classification and previous groin incision. A higher Rutherford class was the only factor correlating with an increase in the ankle-brachial index. When single CFE (48.9% of cases) and hybrid procedures (51.1%) were compared, no significant difference in success or failure was found. Conclusion: Limb ischemia requiring emergency operation and preoperative comorbidity were identified as the most important factors predictive for complications following femoral artery endarterectomy. Combining femoral endarterectomy with an endovascular intervention does not seem to increase the risk of a postoperative complication.

scholarly journals Hybrid Endarterectomy and Endovascular Therapy in Multilevel Lower Extremity Arterial Disease Involving the Femoral Artery Bifurcation

2012 ◽  
Vol 97 (1) ◽  
pp. 56-64 ◽  
Author(s):  
Junjie Zou ◽  
Yongxiang Xia ◽  
Hongyu Yang ◽  
Hao Ma ◽  
Xiwei Zhang
Keyword(s):  
Lower Extremity ◽  
Femoral Artery ◽  
Ankle Brachial Index ◽  
Common Femoral Artery ◽  
Arterial Disease ◽  
Primary Patency ◽  
Secondary Patency ◽  
Hybrid Procedures ◽  
Lower Extremity Arterial Disease ◽  
Group 3

Abstract The objective of this study was to evaluate the feasibility and efficacy of hybrid therapy (combined endarterectomy-endovascular) in patients with complex peripheral multifocal steno-obstructive vascular disease involving the femoral artery bifurcation. Forty-one combined procedures were performed on 40 patients. Although the common femoral artery was usually treated with endarterectomy, endoluminal procedures were performed proximally in 12 patients (group 1), distally in 18 patients (group 2), and both upward and downward in 11 patients (group 3). Patients underwent clinical assessment and ankle-brachial index measurement thereafter. Primary, assisted-primary, and secondary patency rates at 24 months were 59%, 66%, and 72%, respectively. Primary patency rates were lower in group 3 compared with groups 1 and 2 (P  =  0.015). The limb salvage rate was 86.4% at the end of the follow-up period. Hybrid procedures provide feasible and effective treatment management of selected patients with multilevel lower extremity arterial disease involving the femoral artery bifurcation.

scholarly journals Kissing Balloon Technique for Angioplasty of Tibioperoneal Arteries Bifurcation Using Pedal Arterial Retrograde Revascularization

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Ahmed Amro ◽  
Obadah Aqtash ◽  
Adee Elhamdani ◽  
Mehiar El-Hamdani
Keyword(s):  
Femoral Artery ◽  
Clinical Success ◽  
Common Femoral Artery ◽  
Severity Index ◽  
Femoral Access ◽  
Infrapopliteal Artery ◽  
Kissing Balloon Technique ◽  
Balloon Technique ◽  
Bifurcation Lesions ◽  
Procedural Success

Background. Kissing Balloon Technique using retrograde pedal approach together with anterograde common femoral artery (CFA) approach could be the treatment of choice in patients with diseased infrapopliteal artery bifurcation. We report seven cases where the KBT was utilized for the treatment of diseased infrapopliteal artery bifurcation using retrograde pedal access in conjunction with the conventional common femoral artery (CFA) access. Methods. We reviewed all seven cases that underwent KBT with the combination of pedal and common femoral access in a single-center study from 2014 to 2015 utilizing Rutherford classification severity index; all cases were deemed stage 3 (severe claudication) to stage 6 (severe ischemic ulcers or frank gangrene). With the exception of two cases, contralateral femoral access was obtained, with sheath sizes varying from 4 to 6 French for both CFA and pedal access. Ultrasound was utilized for ipsilateral pedal access in all seven cases. Results. Arterial revascularization was successfully achieved by the KBT in all patients without any complications. All patients achieved procedural success, which is defined as residual stenosis of less than 30% with no dissection or thrombosis and clinical success that is defined as resolution of symptoms (absence of intermittent claudication and healing of the ulcer) as well as improvement in the arterial brachial index (ABI). During follow-up, out of the seven cases, repeat angiogram was performed for one case, which showed patent arteries with no residual lesions. Conclusions. In patients with popliteal and tibioperoneal trunk bifurcation lesions, Kissing Balloon Technique using retrograde pedal access in conjunction with the conventional anterograde access appeared to be successful, safe, and effective technique with lower access site complications and shorter procedure time.

scholarly journals Comparison of mid-term graft patency in common femoral versus superficial femoral artery inflow for infra-geniculate bypass in the vascular quality initiative

Vascular ◽  
2020 ◽  
Vol 28 (6) ◽  
pp. 722-730
Author(s):  
Kenneth Tran ◽  
Vy T Ho ◽  
Nathan K Itoga ◽  
Jordan R Stern
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Life Table ◽  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Bypass Graft ◽  
Common Femoral Artery ◽  
Secondary Patency ◽  
Significant Difference

Objectives The superficial femoral artery can be used as inflow for infra-geniculate bypass, but progressive proximal occlusive disease may affect graft durability. We sought to evaluate the effect of superficial femoral artery versus common femoral artery inflow on infra-geniculate bypass patency within a large contemporary multicenter registry. Methods The vascular quality initiative was queried from 2013 to 2019 to identify patients with >30-day patency follow-up, Rutherford chronic limb ischemia stage 1–6, and an infra-geniculate bypass, excluding those with prior ipsilateral bypass. The cohort was stratified by inflow vessel, with primary, primary-assisted, and secondary patency serving as the primary outcome variables. Multivariate Cox-proportional hazard models and radius-based propensity-score matching were performed to reduce treatment-selection bias due to clinical covariates. Results A total of 11,190 bypass procedures were performed (8378 common femoral artery inflow, 2812 superficial femoral artery) on 10,110 patients, with a mean follow-up of 12.8 months (range 1–98). Patients receiving superficial femoral artery inflow bypasses were more commonly male ( p = 0.002), obese ( p < 0.0001) and had chronic, limb threatening ischemia ( p < 0.0001), whereas those with common femoral artery inflow were older ( p < 0.0004), and had higher baseline comorbidities including smoking ( p < 0.0001), coronary disease ( p < 0.0001), and pulmonary disease ( p < 0.0001). On life-table analysis, there was no significant difference in three year estimated primary (32.1 vs 30.1%, p = 0.928), primary assisted (60.5 vs 65.8%, p = 0.191), or secondary patency (62.5 vs 66.7%, p = 0.139) between superficial femoral artery and common femoral artery inflow groups, respectively. A multivariate Cox model found no significant association between inflow vessel and primary patency (0.96 [0.88–1.04], HR [95%CI]), primary-assisted (1.07 [0.95–1.20], HR [95%CI]), or secondary patency (1.08 [0.96–1.22]). In a propensity-matched cohort ( n = 11,151), there were small but statistically significant differences in primary, primary-assisted, and secondary patency at latest follow-up (non-time-to-event data) between groups. The largest difference was observed when evaluating secondary patency, with common femoral artery inflow having a marginally higher secondary patency of 88.1% compared to 85.6% for those with superficial femoral artery inflow at latest follow-up ( p = 0.009). Conclusions Within the vascular quality initiative, there is no significant difference in life-table determined three-year primary, primary-assisted, and secondary patency between infra-geniculate bypasses using common femoral artery inflow compared to superficial femoral artery inflow. Small, statistically significant differences exist in primary, primary-assisted, and secondary patency favoring common femoral artery inflow after propensity score matching. Long-term follow-up data are required in the vascular quality initiative to better evaluate bypass graft durability as this study was limited by a mean follow-up of one year.

Comparison of the Results of Percutaneous Transluminal Angioplasty and Stenting with Medical Treatment for Claudicants Who Have Superficial Femoral Artery Occlusive Disease

Vascular ◽  
2006 ◽  
Vol 14 (2) ◽  
pp. 81-87 ◽  
Author(s):  
Samuel Wilson ◽  
Dmitri Gelfand ◽  
Juan Jimenez ◽  
Ian Gordon
Keyword(s):  
Medical Treatment ◽  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Percutaneous Transluminal Angioplasty ◽  
Ankle Brachial Index ◽  
Transluminal Angioplasty ◽  
Walking Distance ◽  
Control Group ◽  
Early Results ◽  
Percutaneous Transluminal

The outcomes of medical management of peripheral vascular disease localized to the superficial femoral artery (SFA) were compared with those obtained by percutaneous transluminal angioplasty (PTA) with or without stenting in a review of selected studies. The natural history of localized SFA disease is favorable, with major amputation rates less than 10% and revascularization in only 18% of patients over a 10-year interval. Conservative treatment of claudicants shows increases (150%) in walking distance if the ankle brachial index (ABI) is over 0.6 and patients stop smoking. Analysis of 10 trials (882 patients) of PTA with or without stenting found that the overall primary patency rates at 12 months were 71.1% for PTA plus stenting and 58.3% for PTA alone. Technical success with PTA with or without stenting is over 90%, and early results at 6 months are superior to those with exercise. In three randomized controlled trials, however, the difference between PTA and medical treatment at 2 years, whether measured by walking distance or ABI, was not significant, nor was the quality of life. For long-term improvement in walking distance (> 1 year) in the claudicant, intervention is not superior to medical treatment and a monitored exercise program. Consideration should be given to including a nonintervention control group and 2-year outcomes in the evaluation of new SFA stents.

Type I Aneurysmosis: Complementary Index for Diagnosis

Vascular ◽  
2005 ◽  
Vol 13 (1) ◽  
pp. 11-15 ◽  
Author(s):  
Pietro Belardi ◽  
Germano Lucertini ◽  
Giovanni De Caro
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Retrospective Study ◽  
Aortic Aneurysm ◽  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Popliteal Artery ◽  
Control Group ◽  
Type I ◽  
Abdominal Aortic ◽  
Significant Difference

The aim of this study was to investigate the diameters of the superficial femoral artery (SFA) and the popliteal artery (PA) in patients with type I aneurysmosis (diffuse aneurysm in the aortoiliac-common femoral segments combined with arteriomegaly of the femoropopliteal segments). The ratio between these diameters (SFA/PA index) was calculated. A retrospective study was carried out on 76 limbs of 38 patients with type I aneurysmosis. The SFA/PA index calculated on these patients was compared with the index of a control group: 76 limbs of 38 patients with abdominal aortic aneurysm. The SFA/PA index proved to be < 1.00 in the limbs of patients with type I aneurysmosis, whereas it was ≥ 1.00 in all patients with an abdominal aortic aneurysm. There was a statistically significant difference between the type I aneurysmosis group and the control group ( p < .001). This finding can be considered a complementary sign in the diagnosis of type I aneurysmosis.

Hybrid Procedures for Patients With Critical Limb Ischemia and Severe Common Femoral Artery Atherosclerosis

2011 ◽  
Vol 25 (8) ◽  
pp. 1063-1069 ◽  
Author(s):  
Miltiadis Matsagkas ◽  
George Kouvelos ◽  
Eleni Arnaoutoglou ◽  
Nektario Papa ◽  
Nicos Labropoulos ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Common Femoral Artery ◽  
Hybrid Procedures

Comparison of early versus late laser goniopuncture following deep sclerectomy for the management of open-angle glaucoma

2020 ◽  
Vol 104 (10) ◽  
pp. 1384-1389 ◽  
Author(s):  
David Holmes ◽  
Michelle Mei Pik Hui ◽  
Colin Clement
Keyword(s):  
Intraocular Pressure ◽  
Retrospective Study ◽  
Open Angle Glaucoma ◽  
Published Data ◽  
Safe Procedure ◽  
Deep Sclerectomy ◽  
Open Angle ◽  
Survival Curves ◽  
Kaplan Meier ◽  
Significant Difference

PurposeTo compare the outcome of early versus late Nd:YAG laser goniopuncture (LGP) after deep sclerectomy with mitomycin C (DSMMC) for open-angle glaucoma (OAG).MethodsA retrospective study of consecutive OAG eyes that underwent a LGP following DSMMC was recruited between June 2012 and November 2015. Success was defined as intraocular pressure (IOP) less than 21, 18 or 15 mm Hg with a reduction of more than 20% IOP from baseline without (complete success) or with medications (qualified success).Results99 eyes with OAG that underwent DSMMC were recruited into the study. Of these, 49 eyes (49.49%) had undergone LGP post-DSMMC. IOP was significantly reduced following LGP from 28.4 to 11.8 mm Hg. Comparison of Kaplan-Meier survival curves out to 60 months after LGP showed a trend towards better outcomes in the late LGP group with the only statistically significant difference noted for qualified success with IOP target <15 mm Hg. Complications were few with no difference noted between early and late LGP groups.ConclusionThere appears to be a trend towards late LGP being more effective after DSMMC when compared with early LGP; this however was not significant. This study corroborates previous published data confirming LGP is an effective and safe procedure for lowering IOP post-DSMMC procedure.

scholarly journals Evaluation of the effectiveness of the pharmacotherapy scheme “TRIO” in patients with chronic arterial insufficiency of IIb-III degree

2020 ◽  
pp. 241-242
Author(s):  
V.V. Petrushenko
Keyword(s):  
Oxygen Saturation ◽  
Comparison Group ◽  
Ankle Brachial Index ◽  
Lower Extremities ◽  
Walking Distance ◽  
Control Group ◽  
Peripheral Oxygen Saturation ◽  
Significant Difference ◽  
Arterial Insufficiency ◽  
Experimental Group

Background. Occlusive peripheral arterial disease (OPAD) of the lower extremities is a pathological condition; its pathogenetic substrate is an obstruction or narrowing of the lumen of peripheral vessels of various calibres. About 200 million people worldwide suffer from OPAD. The incidence and severity of the disease increase with age. Patients with diabetes are 2-4 times more likely to develop OPAD than those without diabetes. Smoking increases the risk of OPAD by 2.5 times. Objective. To evaluate the effectiveness of the pharmacotherapy regimen “TRIO” in patients with chronic arterial insufficiency of IIb-III degree. Materials and methods. The study included 45 people with confirmed OPAD of the lower extremities and chronic arterial insufficiency of IIb-III degree (62.2 % males, 37.8 % females, mean age – 61 years). Patients in the experimental group (n=20) were prescribed a “TRIO” scheme, which included: 1) a multicomponent isoosmolar solution containing Ringer’s lactate and pentoxifylline (200 ml per day); 2) multicomponent hyperosmolar solution containing sorbitol and sodium lactate (400 ml per day); 3) a solution of L-arginine hydrochloride (100 ml per day). Comparison group was treated by the solution 2 (200 ml per day) and solution 3 (100 ml per day) only. The effectiveness criteria included the distance of painless walking, the intensity of pain according to the visual-analogue scale (VAS), ankle brachial index, and peripheral oxygen saturation. Results and discussion. In the experimental group there was a shorter length of hospital stay (7.9±0.97 days vs. 9.8±1.63 days in the comparison group) and better dynamics of painless walking distance (1st day – 47.50±30.54 m, 7th day – 126.25±72.16 m, in the comparison group: 1st day – 49.00±27.73 m, 7th day – 54.20±33.59 m). Pain syndrome according to VAS also decreased more markedly in the experimental group: from 5.35±1.81 points on day 1 to 3.25±1.68 points on day 7 (in the comparison group – from 5.32±1.63 points on day 1 to 4.80±1.53 points on day 7). There was no significant difference in the ankle brachial index. Peripheral oxygen saturation increased more markedly in the experimental group (from 75.50±7.10 % on day 1 to 90.65±5.07 % on day 7) than in the control group (from 75.72±6.55 % on day 1 to 79.48±6.91 % on day 7). Conclusions. 1. Administration of the pharmacotherapy scheme “TRIO” allows to improve the indicators of the functional state of the vascular bed in patients with chronic arterial insufficiency of IIb-III degree. 2. Manifestations of improvement included lengthening of the distance of painless walking, increase of peripheral blood oxygen saturation, and reduction of the pain severity.

Common femoral artery endarterectomy in the age of endovascular therapy

Vascular ◽  
2018 ◽  
Vol 26 (6) ◽  
pp. 581-590 ◽  
Author(s):  
Mohamed Elsherif ◽  
Wael Tawfick ◽  
Mohamed Elsharkawi ◽  
Ruth Campell ◽  
Niamh Hynes ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Clinical Success ◽  
Limb Ischemia ◽  
Common Femoral Artery ◽  
Arterial Disease ◽  
Primary Patency ◽  
Secondary Patency ◽  
Patient Demographics ◽  
Included Patient ◽  
Aneurysm Repair

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.

Y90 Radioembolization of Liver Tumors via Radial approach – Correlation Between Common Femoral artery and Radial Artery Size

2021 ◽  
Author(s):  
Jarren Adam ◽  
Michael Brockman ◽  
Nisha Kalmadi ◽  
Robert Hanna
Keyword(s):  
Radial Artery ◽  
Femoral Artery ◽  
Liver Tumor ◽  
Liver Tumors ◽  
Smoking Status ◽  
Common Femoral Artery ◽  
Tumor Uptake ◽  
Minimum Diameter ◽  
Significant Difference ◽  
Y90 Radioembolization

Abstract PurposeTypically, before Y90 radioembolization procedure undergoes, a CT is completed and the Barbeau test followed by radial artery ultrasound is used to determine if the artery is sufficiently large for vascular access [1-4]. 2.5 mm is the average radial artery diameter, and a vessel measurement of 2.0 mm is the recommended minimum diameter for safe vessel access, but a diameter of 1.5–2.0 mm can be accessed [4-9]. Our study explores using common femoral artery measurements from the pre-procedure CT abdomen/pelvis to assess in a binary manner if the vessel is sufficiently large to use for radial artery access. Materials and MethodsAll computed tomography scans of yttrium-90(Y90) radioembolization of the liver tumor procedures from January 1, 2015 - December 31, 2019 were retrospectively reviewed. Medical records were used from 47 procedures to gather patients' age, gender, Avastin use, femoral artery size (mm), administer Y90 (%), history of diabetes, and smoking status were recorded. ResultsThe minimum femoral artery size in patients who underwent transradial artery Y90 liver tumor radioembolization was 6 mm, with a mean femoral artery size of 10 mm. A comparative analysis of Y90 liver tumor uptake revealed no significant difference in radioembolization tumor uptake based on the initial site of procedure, transfemoral or transradial artery, (p > 0.81229). ConclusionThe study suggests that femoral arteries can predict radial artery diameter and that a femoral artery diameter of 10 mm should yield high confidence that the patient will be a candidate for transradial approach.

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