TPTh 5.03 Outcomes Following Common Femoral Endarterectomy Without Distal Revascularisation: A Five-Year Cohort

Abstract

Peripheral arterial disease involving the common femoral artery can cause chronic limb-threatening ischaemia (CLTI) and intermittent claudication (IC). Common femoral endarterectomy (CFE) +/- iliac intervention (inflow restoration) can alleviate symptoms, although may be inadequate for advanced CLTI or significant disease distal to this (femoro-popliteal/infra-popliteal). This study reports clinical outcomes following CFE without simultaneous distal intervention. Retrospective observational study of patients with CLTI and (IC) undergoing CFE +/- iliac intervention over a five-year period in a tertiary vascular unit was performed. Patient characteristics, Rutherford scores, Global Limb Anatomic Staging System (GLASS), operative details, and post-operative complications were collected. Outcomes were post-operative resolution of rest pain and healing, walking distance improvement for claudicants, major limb amputation (MLA) and 30-day mortality. There were 79 patients included: 49/79 (62%) were male, median age was 71 and 53/79 (57%) were from Scottish Index Multiple Deprivation (SIMD) quintiles 1-3. An iliac intervention was performed in 30/79 (38%) patients. CLTI (80.6%) predominated with Rutherford score (4-6) and 19.8% had IC (Rutherford score 1-3). Most patients had distal disease: 45/79 (57%) GLASS score III; 13/79 (16%) GLASS score II and 15/79 (19%) GLASS score I. For CLTI 57/62 (92%) reported rest pain resolution, 54/62 (87%) achieved wound healing and 8/62 (13%) progressed to MLA. All IC cases achieved improved walking distance. Thirty-day mortality was 5/79 (6%). In this study isolated inflow correction by CFE +/-iliac intervention can achieve good postoperative outcomes even with distal disease.