Annals of vascular surgery · 2026
Contemporary Outcomes of Isolated Common Femoral Endarterectomy in the Endovascular Era.
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Cabral João Marcelo, Loureiro Luís, Guimarães Catarina Mesquita, Silva Vera, Bandeira Mónica, Cardoso Samuel, Queirós Miguel, Almeida Henrique, Machado Rui
Аннотация
BACKGROUND: Common femoral endarterectomy remains the reference treatment for common femoral artery occlusive disease, yet contemporary real-world data focused specifically on isolated common femoral endarterectomy remain limited. This study aimed to evaluate the clinical profile, operative characteristics and outcomes of isolated common femoral endarterectomy performed in a tertiary vascular surgery center, with particular emphasis on postoperative complications, reintervention and occlusion, as well as the possible influence of wound closure technique and hemostatic adjunct use on local morbidity.
METHODS: A retrospective observational study was conducted including consecutive patients who underwent isolated common femoral endarterectomy between January 2013 and December 2023. Baseline characteristics, clinical presentation, lesion complexity, operative details, postoperative complications, reinterventions and postoperative occlusion were analyzed. Lesions were classified according to TASC II. Kaplan-Meier analysis was used to assess freedom from occlusion, while Cox regression was performed to explore factors associated with postoperative occlusion. Fisher's exact test was used to assess associations between wound closure technique, hemostatic adjunct use and postoperative complications.
RESULTS: A total of 96 patients underwent 100 isolated common femoral endarterectomies. Mean age was 68.5 ± 9 years, 89% were male and 63% presented with chronic limb-threatening ischemia. Most lesions were classified as TASC A-B (68%). Median follow-up was 3.5 years (95% CI, 3.2-3.9). Early postoperative complications were predominantly local, including groin hematoma (4%), lymphatic leakage (4%), lymphocele (5%), pseudoaneurysm (2%) and infection (8%). Overall, 18% of procedures required reintervention, with 14% undergoing open and 4% endovascular reintervention. Nine occlusive events occurred during follow-up. Estimated freedom from occlusion was 100% at 30 days, 96% at 1 year and 86% at 5 years. TASC C-D lesions showed a numerically higher occlusion rate than TASC A-B lesions (12.5% vs. 7.4%; OR, 1.80), although this difference was not statistically significant (p = 0.462). In univariable Cox regression, aspirin therapy was the only variable significantly associated with lower risk of postoperative occlusion (HR, 0.20; p = 0.026). Neither intradermal wound closure nor hemostatic adjunct use was significantly associated with postoperative complications.
CONCLUSIONS: Isolated common femoral endarterectomy remains a safe and durable treatment for common femoral artery occlusive disease, with low rates of early local complications, acceptable reintervention rates and good freedom from occlusion during follow-up. These findings support the continued role of isolated common femoral endarterectomy as the reference treatment for common femoral artery disease in the endovascular era.
METHODS: A retrospective observational study was conducted including consecutive patients who underwent isolated common femoral endarterectomy between January 2013 and December 2023. Baseline characteristics, clinical presentation, lesion complexity, operative details, postoperative complications, reinterventions and postoperative occlusion were analyzed. Lesions were classified according to TASC II. Kaplan-Meier analysis was used to assess freedom from occlusion, while Cox regression was performed to explore factors associated with postoperative occlusion. Fisher's exact test was used to assess associations between wound closure technique, hemostatic adjunct use and postoperative complications.
RESULTS: A total of 96 patients underwent 100 isolated common femoral endarterectomies. Mean age was 68.5 ± 9 years, 89% were male and 63% presented with chronic limb-threatening ischemia. Most lesions were classified as TASC A-B (68%). Median follow-up was 3.5 years (95% CI, 3.2-3.9). Early postoperative complications were predominantly local, including groin hematoma (4%), lymphatic leakage (4%), lymphocele (5%), pseudoaneurysm (2%) and infection (8%). Overall, 18% of procedures required reintervention, with 14% undergoing open and 4% endovascular reintervention. Nine occlusive events occurred during follow-up. Estimated freedom from occlusion was 100% at 30 days, 96% at 1 year and 86% at 5 years. TASC C-D lesions showed a numerically higher occlusion rate than TASC A-B lesions (12.5% vs. 7.4%; OR, 1.80), although this difference was not statistically significant (p = 0.462). In univariable Cox regression, aspirin therapy was the only variable significantly associated with lower risk of postoperative occlusion (HR, 0.20; p = 0.026). Neither intradermal wound closure nor hemostatic adjunct use was significantly associated with postoperative complications.
CONCLUSIONS: Isolated common femoral endarterectomy remains a safe and durable treatment for common femoral artery occlusive disease, with low rates of early local complications, acceptable reintervention rates and good freedom from occlusion during follow-up. These findings support the continued role of isolated common femoral endarterectomy as the reference treatment for common femoral artery disease in the endovascular era.