Homer Stryker School of Medicine, Western Michigan University, Kalamazoo, MI.
Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, IL.
J Vasc Surg. 2024 Jul;80(1):199-203. doi: 10.1016/j.jvs.2024.01.211. Epub 2024 Feb 14.
Common femoral endarterectomy (CFE) comprises the current standard-of-care for symptomatic common femoral artery occlusive disease. Although it provides effective inflow revascularization via a single incision, it remains an invasive procedure in an often-frail patient population. The purpose of this retrospective clinical study was to assess the morbidity and mortality of CFE in a contemporary cohort.
Consecutive CFEs performed at a large, urban hospital were reviewed. Six-month mortality, local complications (hematoma, lymphatic leak, pseudoaneurysm, wound infection, and/or dehiscence), and systemic complications were analyzed using univariate and multivariate analyses.
A total of 129 isolated CFEs were performed over 7 years for claudication (36%), rest pain (16%), tissue loss (29%), or acute on chronic limb ischemia (21%). Mean age was 75 ± 9 years, and 68% of patients were male. Comorbidities were prevalent, including coronary artery disease (54%), diabetes (41%), chronic pulmonary disease (25%), and congestive heart failure (22%). The majority of CFEs were performed under general anesthesia (98%) with patch angioplasty using bovine pericardium (73% vs 27% Dacron). Twenty-two patients (17%) sustained local complications following the procedure; their occurrence was significantly associated with obesity (P = .002) but no technical or operative factors. Nineteen patients (15%) sustained serious systemic complications; their occurrence was significantly associated with chronic limb-threatening ischemia (P < .001), and a high American Society of Anesthesiologists (ASA) class (P = .002). By 6 months, 17 patients (13%) had died. Being on dialysis, presenting with chronic limb-threatening ischemia, and being in a high ASA class at the time of operation were all associated with 6-month mortality; a high ASA class at the time of operation was independently predictive of mortality (odds ratio, 3.08; 95% confidence interval, 1.03-9.24; P = .044).
Although commonly performed, CFE is not a benign vascular procedure. Disease presentation, anesthetic risk, and expected longevity play an important role in clinical outcomes. Evolving endovascular approaches to the common femoral artery could serve to reduce morbidity and mortality in the future.
股总动脉内膜切除术（CFE）是目前治疗有症状的股总动脉闭塞性疾病的标准治疗方法。虽然它通过单一切口提供了有效的流入血管重建，但它仍然是一种在通常脆弱的患者群体中进行的侵入性手术。本回顾性临床研究的目的是评估当代队列中 CFE 的发病率和死亡率。
对一家大型城市医院进行的连续 CFE 进行了回顾性分析。使用单变量和多变量分析，分析了 6 个月的死亡率、局部并发症（血肿、淋巴漏、假性动脉瘤、伤口感染和/或裂开）和全身并发症。
7 年内共进行了 129 例孤立的 CFE，用于跛行（36%）、静息痛（16%）、组织缺失（29%）或急性慢性肢体缺血（21%）。平均年龄为 75±9 岁，68%的患者为男性。合并症普遍存在，包括冠状动脉疾病（54%）、糖尿病（41%）、慢性肺部疾病（25%）和充血性心力衰竭（22%）。大多数 CFE 在全身麻醉（98%）下进行，使用牛心包进行补片血管成形术（73%比 27%的涤纶）。22 例（17%）患者在手术后出现局部并发症；其发生与肥胖显著相关（P=0.002），但与技术或手术因素无关。19 例（15%）患者发生严重的全身并发症；其发生与慢性肢体威胁性缺血显著相关（P<0.001），以及高美国麻醉师协会（ASA）分级（P=0.002）显著相关。在 6 个月时，有 17 例（13%）患者死亡。接受透析、表现为慢性肢体威胁性缺血以及手术时 ASA 分级较高的患者在 6 个月时的死亡率均较高；手术时 ASA 分级较高是独立预测死亡率的因素（比值比，3.08；95%置信区间，1.03-9.24；P=0.044）。
尽管 CFE 是一种常用的血管手术，但它并不是一种良性手术。疾病表现、麻醉风险和预期寿命在临床结果中起着重要作用。未来，新兴的股总动脉腔内治疗方法可能会降低发病率和死亡率。
