Comparison of Clinical Outcomes in Patients Undergoing Common Femoral Thromboendarterectomy With or Without Patch Angioplasty

Taira Kobayashi; Mitsuyoshi Takahara; Naoki Fujimura; Shigeo Ichihashi; Toshifumi Kudo; Jun Okadome; Hideaki Obara; Tatsuya Nakama; Kenji Suzuki; Terutoshi Yamaoka

doi:10.1016/j.ejvs.2023.03.034

Comparison of Clinical Outcomes in Patients Undergoing Common Femoral Thromboendarterectomy With or Without Patch Angioplasty

Eur J Vasc Endovasc Surg. 2023 Jun;65(6):870-877. doi: 10.1016/j.ejvs.2023.03.034. Epub 2023 Mar 24.

Authors

Affiliations

¹ Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hatsukaichi, Japan. Electronic address: ja-t-coba@hotmail.co.jp.
² Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
³ Department of Vascular Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan.
⁴ Department of Radiology, Nara Medical University, Kashihara, Japan.
⁵ Division of Vascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
⁶ Department of Vascular Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Japan.
⁷ Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
⁸ Department of Cardiology, Tokyo Bay Medical Center, Urayasu, Japan.
⁹ Department of Cardiology, Tokyo Saiseikai Central Hospital, Tokyo, Japan.
¹⁰ Department of Vascular Surgery, Matsuyama Red Cross Hospital, Ehime, Japan.

PMID: 36967011
DOI: 10.1016/j.ejvs.2023.03.034

Abstract

Objective: Surgical thromboendarterectomy (TEA) is the standard treatment for an occlusive lesion of the common femoral artery (CFA). However, there is limited knowledge on the need for patch angioplasty in CFA TEA. The objective of this study was to compare the peri-operative and two year results of CFA TEA with or without patch angioplasty.

Methods: A multicentre retrospective observational study was performed at 34 Japanese centres. Comparisons were made between patients undergoing CFA TEA with or without patch angioplasty after propensity score matching (PSM). The primary endpoints were primary patency and freedom from target lesion revascularisation (TLR) of the TEA lesion. The secondary endpoints were hospital outcomes, limb salvage, and overall survival.

Results: Between 2018 and 2020, 428 TEA procedures (237 with patch angioplasty and 191 with primary closure) were performed. PSM extracted 151 pairs with no significant intergroup differences in baseline characteristics. Peri-operative death and complications occurred in 0.7% vs. 1.3% (p = 1.0) and 6.0% vs. 6.6% (p = 1.0), respectively. The follow up rate was 96% over a median follow up of 14.9 months (interquartile range 8.3, 24.3). Loss of primary patency occurred in 18 patients. The two year primary patency of patch angioplasty cases was statistically significantly higher than that of primary closure cases (97.0% vs. 89.9%; p = .021). TLR was performed in 14 patients. The two year freedom from TLR in patch angioplasty cases was also statistically significantly higher than in primary closure cases (98.6% vs. 92.9%; p = .003). During follow up, seven limbs required major amputation and 40 patients died. There was no statistically significant difference in limb salvage and survival between the two groups after PSM.

Conclusions: This is the first report to show that patch angioplasty may decrease re-stenosis and target lesion revascularisation of CFA TEA lesions.

Keywords: Clinical outcomes; Common femoral endarterectomy; Patch angioplasty; Primary patency; Target lesion revascularisation.

Publication types

Observational Study

MeSH terms

Angioplasty / adverse effects
Angioplasty, Balloon* / adverse effects
Endarterectomy* / adverse effects
Endarterectomy* / methods
Femoral Artery / diagnostic imaging
Femoral Artery / surgery
Humans
Limb Salvage
Retrospective Studies
Treatment Outcome
Vascular Patency
Vascular Surgical Procedures