Outpatient common femoral artery stenting for occlusive disease: Short-, mid-, and long-term results.

Abstract

Stenting of the common femoral artery (CFA) remains controversial despite advancements in technology and technique. We report on an updated and expanded list of patients previously shown to demonstrate the safety and efficacy of CFA stents. We retrospectively reviewed data from 296 unique patients with 349 CFA lesions treated with endovascular CFA stents performed by 12 vascular surgeons in an outpatient office-based angiosuite from 2012 to 2021. All patients were American Society of Anesthesiologists class III or IV and Rutherford class 3 or higher. Patients were 139 women (47%) and 157 men (53%) with an average age of 71 years at the time of intervention. Surgical indications included claudication (42%), rest pain (42%), and ulcer or gangrene (16%). Common comorbidities were hypertension (89%), hyperlipidemia (69%), diabetes mellitus (46%), and hemodialysis (16%). Patency outcomes were measured by ankle-brachial index readings and duplex ultrasound examinations at 1 week, 3 months, 6 months, and every 6 months thereafter. The average length of follow-up was 22 months (range, 0-96 months). Our primary end point was stent patency free from reintervention. Safety outcomes were measured within 24 hours and again at 30 days. Postoperative complications were defined as events requiring transfer to hospital, extra treatment, and/or extra observation. Kaplan-Meier curves were used to evaluate patency outcomes. Cox proportional hazard regression models were used to determine correlation between outcomes and comorbidities. Primary patency was 72.5% and primary-assisted patency was 95.7%. Twelve limbs (3.9%) thrombosed with four limbs unable to be revascularized, achieving a secondary patency of 99.1%. There were 13 (3.7%) adverse events within 30 days. Long-term complications included two stent thromboses, two pseudoaneurysms, one stent dissection, one stent migration, and one hematoma >30 days after the procedure. Limb loss was 4.3% with 7 below-knee amputations and 8 above-knee amputations out of the 349 treated limbs. Previous myocardial infarction correlated with loss of primary patency (P = .002). Patients with ulcer/gangrene were 1.8 times more likely to lose primary patency compared with those with claudication (P = .035). Patients with ulcer/gangrene (P = .045) and rest pain (P = .007) compared with patients with claudication were 9.5 times and 4.9 times more likely to have limb loss, respectively. Survival was 70% at ≤75 months. Our results show that CFA stenting is safe and effective and provides durable long-term primary-assisted and secondary patency. Although primary patency for stenting is suboptimal, complication rates are notably lower than with femoral endarterectomy. The stenting also demonstrated long-term limb salvage, with only a 4.3% limb loss rate and an overall survival of 70.0% at 75 months. Thus, CFA stenting offers a suitable alternative to endarterectomy in select cases.