Guy's and St Thomas' NHS Foundation Trust, London, UK.
Guy's and St Thomas' NHS Foundation Trust, London, UK.
Eur J Vasc Endovasc Surg. 2022 Dec;64(6):684-691. doi: 10.1016/j.ejvs.2022.08.034. Epub 2022 Sep 6.
Advances in endovascular technologies have allowed the treatment of common femoral artery (CFA) steno-occlusive disease by minimally invasive means; however, the proportion of lesions treated with common femoral artery endarterectomy (CFAE) which would be amenable to endovascular treatment is unknown. This observational study aimed to describe the morphology and composition of CFA lesions treated with CFAE and report the proportion that would be amenable to endovascular treatment with modern technologies.
Patients presenting with symptomatic peripheral artery disease who underwent CFAE from January 2014 to December 2018 in two tertiary NHS hospitals were included. Extensive data relating to patient demographics, risk factors, clinical outcomes, as well as anatomical and morphological characteristics of the CFA atherosclerotic lesions, were collected which included detailed plaque analysis using 3D reconstruction of pre-operative computed tomography angiograms. CFA lesions were considered suitable for endovascular treatment if presented with patent iliac inflow, at least one patent outflow vessel (superficial femoral artery [SFA] or profunda femoral artery [PFA]), and stenotic rather than occluded CFA.
A total of 829 CFAs in 737 consecutive patients who underwent CFAE were included (mean age 71 ± 10 years; 526 males, 71%); 451 (62%) presented with chronic limb threatening ischaemia. Overall, 35% of CFAs had a localised lesion (no bifurcation disease) that could possibly be treated endovascularly. In total, 376 (45%) target vessels did not feature severe calcium load, with a patent CFA, PFA, and proximal SFA and therefore would have been amenable to endovascular treatment; while 271 CFAs (33%) featured a significant calcium load which would have potentially required stenting.
A significant proportion of patients with atherosclerotic CFA lesions who undergo surgery could potentially be candidates for endovascular treatment. A randomised trial comparing CFAE and new endovascular techniques in this clinical context is required.
腔内技术的进步使得通过微创手段治疗股总动脉（CFA）狭窄闭塞性疾病成为可能；然而，适合腔内治疗的 CFA 动脉内膜切除术（CFAE）治疗病变的比例尚不清楚。本观察性研究旨在描述 CFAE 治疗的 CFA 病变的形态和成分，并报告采用现代技术进行腔内治疗的适合比例。
纳入 2014 年 1 月至 2018 年 12 月在两家三级 NHS 医院因症状性外周动脉疾病而行 CFAE 的患者。收集了与患者人口统计学、危险因素、临床结果以及 CFA 动脉粥样硬化病变的解剖和形态特征相关的广泛数据，包括使用术前计算机断层血管造影的 3D 重建进行详细的斑块分析。如果 CFA 存在通畅的髂内流入道、至少一条通畅的流出血管（股浅动脉[SFA]或股深动脉[PFA]）和狭窄而非闭塞的 CFA，则认为 CFA 病变适合腔内治疗。
共纳入 737 例连续患者的 829 条 CFA（平均年龄 71 ± 10 岁；526 例男性，71%）；451 例（62%）出现慢性肢体威胁性缺血。总体而言，35%的 CFA 具有局部病变（无分叉病变），可能可以通过腔内治疗进行治疗。总共 376 条（45%）靶血管没有严重的钙负荷，具有通畅的 CFA、PFA 和近端 SFA，因此可以进行腔内治疗；而 271 条 CFA（33%）存在明显的钙负荷，可能需要支架置入。
接受手术治疗的 CFA 动脉粥样硬化病变患者中有相当大的比例可能适合腔内治疗。在这种临床情况下，需要进行 CFAE 与新的腔内技术比较的随机试验。
