Comparative efficacy of open endarterectomy versus endovascular treatments in common femoral artery stenocclusive disease: A Bayesian hierarchical meta-analysis.

BackgroundThe management of Common Femoral Artery (CFA) stenocclusive disease presents unique challenges, with debates persisting regarding the optimal treatment strategy between Open Common Femoral Endarterectomy (CFE) and Endovascular Therapy (EVT). This study aimed to compare the efficacy of CFE versus EVT, as well as simple versus advanced EVT (aEVT), using a Bayesian hierarchical framework.MethodsA systematic review was conducted according to PRISMA guidelines by querying PubMed, ScienceDirect, Scopus, and the Cochrane Library for articles published through June 2024. The study included randomized controlled trials and retrospective observational studies with a minimum of 40 patients per cohort. Data were synthesized using a Bayesian random-intercept logistic model to estimate pooled Odds Ratios (OR) for primary patency, freedom from reintervention, and limb salvage.ResultsThe analysis included 10 comparative studies encompassing 1452 patients. Open CFE demonstrated superior outcomes compared to EVT, with a significantly reduced odds of patency loss (OR 0.480; 95% CrI: 0.367-0.626) and lower reintervention rates (OR 0.534; 95% CrI: 0.391-0.718). Limb salvage rates also favored CFE (OR 0.548; 95% CrI: 0.402-0.737). In subgroup analyses, advanced EVT (involving atherectomy) improved primary patency compared to simple EVT (OR 0.520; 95% CrI: 0.306-0.883) but did not statistically significantly reduce the need for reintervention (OR 0.910; 95% CrI: 0.427-1.894).ConclusionOpen CFE remains the gold standard for CFA stenocclusive disease, offering superior long-term durability and limb salvage compared to endovascular interventions. While advanced endovascular techniques improve patency rates compared to simple balloon angioplasty, they fail to significantly reduce reintervention rates, likely due to the biomechanical stress of the femoral region. EVT should be considered a pragmatic option reserved primarily for high-surgical-risk patients.