Evaluation of Common Femoral Endarterectomy for the Management of Focal Atherosclerotic Disease

Abstract

Although uncommon, focal atherosclerotic lesions of the common femoral artery (CFA) are frequently responsible for disabling ischemic symptoms owing to their proximal location. The authors retrospectively identified 51 patients who between 1983 and 1995 underwent 53 common femoral endarterectomies (CFE) for occlusion (19) or hemodynamically significant (< 70%) stenoses (34). Operative indications included disabling claudication (21%), rest pain (45%), and nonhealing ulcers (34%). In Group 1, patients underwent CFE alone (37 limbs); in Group 2, CFE was combined with a distal bypass (16 limbs). CFA patency was ascertained by physical examination, limb pressures, and pulse volume recordings, with a mean follow-up of 40 months. Cumulative life-table CFA primary patency rates for all extremities were 95%, 85%, and 82% at 1, 3, and 5 years. CFA patency at 1, 3, and 5 years was 94%, 82%, and 77% in Group 1, compared to 100%, 92%, and 92% in Group 2 (p = 0.33, p = 0.34, p = 0.26). Sixty percent of patients with late failures were found to have an inherited hypercoagulable state. The 5-year limb salvage rate was 90% in Group 1 and 94% in Group 2 (p = 0.9). Postoperatively, limbs became asymptomatic, clinically improved, or deteriorated in 35%, 46%, and 19%, respectively of Group 1, compared with 44%, 50%, and 6% of Group 2 (p = 0.6). Focal atherosclerotic lesions of the common femoral artery can be successfully managed by common femoral endarterectomy with acceptable 5-year patency, limb salvage rates, and relief of symptoms.