Document Detail


Long-term results of combined common femoral endarterectomy and iliac stenting/stent grafting for occlusive disease.
MedLine Citation:
PMID:  18572359     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Common femoral artery (CFA) endarterectomy with iliac stenting or stent grafting can be an alternative to traditional open surgery in patients with aortoiliac occlusive disease. We report the long-term outcomes of this approach.
METHODS: Patients undergoing CFA endarterectomy with simultaneous iliac stenting/stent grafting between 1997 and 2006 were retrospectively reviewed. Technical success, clinical and hemodynamic outcomes, and 5-year patency using life-table methodology were determined. Factors associated with reintervention and mortality were determined by logistic regression analysis.
RESULTS: A total of 171 patients (mean age, 67 +/- 10 years; 38% female; 35% diabetic) underwent 193 CFA endarterectomies and iliac stent/stent grafting. Indications were rest pain (32%), tissue loss (22%), and claudication (46%). External iliac artery (EIA) lesions were present in 39%, and combined common iliac artery (CIA) and EIA lesions were seen in 61% of patients. Complete CIA/EIA occlusions were present in 41% of patients. Stent grafts were used in 41% of patients. Technical success occurred in 98% of patients. Clinical improvement was seen in 92% of patients. Mean ankle-brachial index increased from 0.38 +/- 0.32 to 0.72 +/- 0.24. Median length of stay was 2 days (range, 1-51 days). Thirty-day mortality was 2.3% and 5-year survival was 60%. Five-year primary, primary-assisted, and secondary patencies were 60%, 97%, and 98% respectively. Endovascular reintervention was required in 14% of patients; inflow surgical procedures were required in 10%. By logistic regression analysis, use of stent grafts compared with bare stents was associated with significantly higher primary patency (87% +/- 5% vs 53% +/- 7%; P < .01).
CONCLUSION: Combined CFA endarterectomy with iliac intervention yield acceptable long-term results. The use of stent grafts compared with bare stents is associated with improved primary patency.
Authors:
Robert W Chang; Philip P Goodney; Jennie H Baek; Brian W Nolan; Eva M Rzucidlo; Richard J Powell
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Publication Detail:
Type:  Journal Article     Date:  2008-06-24
Journal Detail:
Title:  Journal of vascular surgery     Volume:  48     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-07-22     Completed Date:  2008-08-22     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  362-7     Citation Subset:  IM    
Affiliation:
Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Analysis of Variance
Angiography, Digital Subtraction / methods
Arterial Occlusive Diseases / mortality,  radiography,  surgery*
Balloon Dilation / methods*
Cohort Studies
Combined Modality Therapy
Endarterectomy / methods*
Female
Femoral Artery / surgery*
Follow-Up Studies
Graft Survival
Humans
Iliac Artery*
Intermittent Claudication / diagnosis,  surgery
Kaplan-Meier Estimate
Logistic Models
Male
Middle Aged
Multivariate Analysis
Retrospective Studies
Risk Assessment
Severity of Illness Index
Stents*
Survival Analysis
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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