Long-term results of combined common femoral endarterectomy and iliac stenting/stent grafting for occlusive disease

Chang, Robert W. MD
Goodney, Philip P. MD
Baek, Jennie H. BS
Nolan, Brian W. MD
Rzucidlo, Eva M. MD
Powell, Richard J. MD

Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.

Reprint requests: Richard J. Powell, MD, Section of Vascular Surgery, One Medical Center Drive, Ste 3V, Lebanon, NH 03756 (e-mail: [email protected]).

Competition of interest: none.

Presented at the Thirty-fourth Annual Meeting of the New England Society for Vascular Surgery, Ledyard, Conn, Oct 5-7, 2007.

Received November 5, 2007; accepted March 21, 2008

Journal of Vascular Surgery 48(2):p 362-367, August 2008.

Background:

Common femoral artery (CFA) endarterectomy with iliac stenting or stent grafting can be an alternative to traditional open surgery in patients with aortoiliac occlusive disease. We report the long-term outcomes of this approach.

Methods:

Patients undergoing CFA endarterectomy with simultaneous iliac stenting/stent grafting between 1997 and 2006 were retrospectively reviewed. Technical success, clinical and hemodynamic outcomes, and 5-year patency using life-table methodology were determined. Factors associated with reintervention and mortality were determined by logistic regression analysis.

Results:

A total of 171 patients (mean age, 67 ± 10 years; 38% female; 35% diabetic) underwent 193 CFA endarterectomies and iliac stent/stent grafting. Indications were rest pain (32%), tissue loss (22%), and claudication (46%). External iliac artery (EIA) lesions were present in 39%, and combined common iliac artery (CIA) and EIA lesions were seen in 61% of patients. Complete CIA/EIA occlusions were present in 41% of patients. Stent grafts were used in 41% of patients. Technical success occurred in 98% of patients. Clinical improvement was seen in 92% of patients. Mean ankle-brachial index increased from 0.38 ± 0.32 to 0.72 ± 0.24. Median length of stay was 2 days (range, 1-51 days). Thirty-day mortality was 2.3% and 5-year survival was 60%. Five-year primary, primary-assisted, and secondary patencies were 60%, 97%, and 98% respectively. Endovascular reintervention was required in 14% of patients; inflow surgical procedures were required in 10%. By logistic regression analysis, use of stent grafts compared with bare stents was associated with significantly higher primary patency (87% ± 5% vs 53% ± 7%;P< .01).

Conclusion:

Combined CFA endarterectomy with iliac intervention yield acceptable long-term results. The use of stent grafts compared with bare stents is associated with improved primary patency.