Long-term Outcome after Isolated Endarterectomy of the Femoral Bifurcation
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Long-term outcome after endarterectomy of the femoral bifurcation has not been widely investigated, and the aim of this study was to assess its late results from a community-wide perspective.
Patients and Methods
Between 1983 and 2006 111 isolated endarterectomies of the common femoral artery and/or the proximal part of the superficial femoral artery or profunda femoris were performed in 90 patients at the Oulu University Hospital, Oulu, Finland. A total of 77 limbs were treated surgically for claudication and 34 others for critical limb ischemia. Angiographic findings of 100 extremities were evaluated.
The in-hospital mortality rate was 1.8%. The mean follow-up period was 5.9 years. At 5-, 10-, and 15-year follow-up the overall survival was 60.5%, 32.7%, and 17.6%, respectively (S.E < 0.05). A C-reactive protein value ≥ 10 mg/l was predictive of poor late survival (p = 0.008). Limb salvage rates after isolated femoral endarterectomy at 5-, 10-, and 15-year follow-up were 93.7%, 93.7%, and 85.2%, respectively (S.E. < 0.08). Critical limb ischemia (p = 0.006) and current smoking (p = 0.027) were independent predictors of major lower limb amputation. A total of 41 limbs were subjected to ipsilateral vascular procedures after femoral endarterectomy, only one of which was re-endarterectomy. Freedom from any ipsilateral revascularization procedure at 5-, 10-, and 15-year follow-up was calculated at 68.0%, 50.6%, and 42.5%, respectively (S.E. < 0.08). The overall linearized rate of reintervention on the ipsilateral limb was 0.16 ± 0.44/year. The linearized rate among patients who had any ipsilateral vascular reintervention was 0.43 ± 0.66/year.
Isolated femoral endarterectomy is a rather low-risk and durable procedure. However, a significant number of reinterventions distal or proximal to the endarterectomized site can be expected in one third of patients.
KeywordsSuperficial Femoral Artery Revascularization Procedure Critical Limb Ischemia Common Femoral Artery Major Amputation
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