Halpin David, Erben Young, Jayasuriya Sasanka, Cua Bennett, Jhamnani Sunny, Mena-Hurtado Carlos
1 Department of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, CT, USA.
2 Department of Surgery, Vascular Surgery, Yale New Haven Hospital, New Haven, CT, USA.
Vasc Endovascular Surg. 2017 May;51(4):220-227. doi: 10.1177/1538574417702773. Epub 2017 Apr 4.
Common femoral endarterectomy (CFE) remains the standard of care for treatment of atherosclerotic stenosis of the common femoral artery (CFA). Endovascular interventions have become the first-line therapy for atherosclerotic disease of the aortoiliac and femoropopliteal systems. Recent reports have documented high rates of technical success and low rates of complications with endovascular management of CFA stenosis. This study is a contemporary review of the surgical and endovascular literature on the management CFA stenosis and compares the results of these methods.
A search of OVID Medline identified all published reports of revascularization of isolated atherosclerotic CFA stenosis. For each study selected for review, the number of patients, number of limbs treated, percentage of patients with critical limb ischemia, and mean length of follow-up was recorded. Study end points included survival, primary patency, freedom from target lesion revascularization (TLR), freedom from amputation, and complications.
The review included 7 CFE studies and 4 endovascular studies. Survival was similar between the groups. Primary patency was consistently higher with CFE compared to endovascular therapy. Freedom from TLR was lower with CFE compared to endovascular therapy. Morbidity and mortality was also higher with CFE compared to endovascular therapy. Freedom from amputation was not consistently reported in the endovascular studies.
There is limited data to support endovascular treatment of isolated CFA atherosclerosis. CFE has durable results, but there is significant morbidity and mortality resulting from this procedure. Endovascular interventions have low rates of complications, high rates of technical success, good short-term patency but increased need for repeat interventions when compared to surgery. Further trial data comparing CFE with endovascular therapy is needed to guide the management of CFA stenosis.
股总动脉内膜切除术（CFE）仍然是治疗股总动脉（CFA）动脉粥样硬化性狭窄的标准治疗方法。血管内介入治疗已成为主髂动脉和股腘动脉系统动脉粥样硬化疾病的一线治疗方法。最近的报告记录了CFA狭窄血管内治疗的高技术成功率和低并发症发生率。本研究是对关于CFA狭窄治疗的外科和血管内文献的当代综述，并比较了这些方法的结果。
检索OVID Medline以确定所有已发表的关于孤立性动脉粥样硬化性CFA狭窄血运重建的报告。对于每项入选综述的研究，记录患者数量、治疗的肢体数量、严重肢体缺血患者的百分比以及平均随访时间。研究终点包括生存率、原发性通畅率、免于靶病变血运重建（TLR）、免于截肢以及并发症。
该综述包括7项CFE研究和4项血管内研究。两组之间的生存率相似。与血管内治疗相比，CFE的原发性通畅率始终更高。与血管内治疗相比，CFE的免于TLR率更低。与血管内治疗相比，CFE的发病率和死亡率也更高。血管内研究中未一致报告免于截肢情况。
支持孤立性CFA动脉粥样硬化血管内治疗的数据有限。CFE有持久的效果，但该手术会导致显著的发病率和死亡率。与手术相比，血管内介入治疗并发症发生率低、技术成功率高、短期通畅性好，但重复干预的需求增加。需要进一步的试验数据来比较CFE与血管内治疗，以指导CFA狭窄的管理。
