Endovascular Treatment of the Common Femoral Artery Studied in the Vascular Quality Initiative
January 4, 2016—Findings from a study of endovascular treatment of the common femoral artery (CFA) in the Society for Vascular Surgery's Vascular Quality Initiative were published by Jeffrey J. Siracuse, MD, et al online ahead of print in the Journal of Vascular Surgery (JVS). The study was first presented at the 2016 Vascular Annual Meeting of the Society for Vascular Surgery, which was held in June in National Harbor, Maryland.
The investigators noted that endovascular interventions of the CFA and deep femoral artery (DFA) are becoming more common, but there are very little published data for guidance. This study sought to analyze practice patterns and outcomes from these interventions.
As summarized in JVS, the investigators queried the Vascular Quality Initiative for all endovascular interventions of the CFA and DFA from 2010 to 2015. The study excluded cases that were emergent or for acute limb ischemia. Investigators analyzed patients who received isolated CFA intervention with or without DFA treatment.
Of 1,014 patients, 946 had an isolated CFA intervention with a DFA intervention and 68 patients had an isolated CFA intervention without a DFA intervention (average age, 67.4 ± 10.8 years; 59% male). Indications were claudication (67%), rest pain (16.3%), and tissue loss (16.7%). Periprocedural complications were access site hematoma (5.2%), arterial dissection (2.9%), distal embolization (0.7%), access site stenosis/occlusion (0.5%), and arterial perforation (0.6%).
Thirty-day mortality was 1.6%. Survival was 92.9% and 87.2% at 1 and 3 years, respectively. Amputation-free survival, freedom from loss of patency or death, and reintervention-free survival were 93.5%, 83%, and 87.5% at 1 year, respectively (Kaplan-Meier analysis). Multivariable predictors of mortality were tissue loss, chronic obstructive pulmonary disease (COPD), end-stage renal disease, case urgency, and age, whereas aspirin use and non-Caucasian race were protective.
Tissue loss, rest pain, COPD, end-stage renal disease, stent use, nonambulatory status, and female sex were predictive of major amputation, whereas aspirin use, P2Y12 antagonist use, statin use, and initial technical success were protective. Tissue loss, case urgency, and nonambulatory status predicted patency loss or death. Tissue loss, COPD, stent use, and history of previous bypass predicted reintervention.
The investigators concluded that the data demonstrated that endovascular interventions of the CFA/DFA have a low rate of periprocedural morbidity and mortality, with lower 1-year patency than what was historically observed for CFA endarterectomy. Stent use is associated with reinterventions and amputation. Longer-term analysis is needed to better assess durability, advised the investigators in JVS.