Background

Due to the rapid development of techniques the treatment of peripheral arterial disease (PAD) is nowadays predominantly interventional. An exception are lesions of the common femoral artery (CFA), which should be treated surgically according to vascular guidelines. However, recent evidence has shown that endovascular techniques, e.g., stenting, have comparable clinical outcomes while causing fewer complications. The aim of the present analysis was to evaluate the therapeutic success of endovascular therapy of CFA lesions in a single center, all - comers registry. 

Methods

All patients who were treated for a CFA lesion at the Department of Internal Medicine I of the University Hospital Jena in the period from 01.01.2017 to 31.12.2020 were included. Treatment success was determined by evaluating the ABI determined pre- and post-interventional as well as during follow-up and by changing the standardized walking distance.

Results

The analysis included 109 patients with a median age of 73, 4 years, with 67% (73) of those being  men. Eighty cases (73,4 %) had stenosis, 27 (24,8 %) occlusion, and 2 cases had hemorrhage at the CFA. There were 72 interventional, 33 surgical, and 4 conservative follow-up treatments. Emergency care was required in 18% (n=20). 

Of the 72 interventional patients, 30 were treated with a DCB, 9 with a stent, 22 via scoring balloon, 16 with the lithoplasty procedure, and one patient with lysis (combinations possible). Among patients treated surgically, 84% were treated via thrombendarterectomy, 4 with bypass, and one patient by thrombectomy. Resting ABI in the overall collective showed an increase from 0.5 to 0.7 (post intervention), with ABI increasing from 0.6 initially to 0.8 at follow-up in the interventional therapy group and from 0.3 to 0.6 in the surgically treated group. In the intervention group, complications included 4 pseudoaneurysms and one occlusion of the access site by implantation of a closure device. In the surgically treated group, 6 postoperative complications occurred.

Conclusion

The present analysis demonstrates that even in the real-world, all-commers collective, interventional therapy for CFA lesions was safe and equally effective as the surgically treated patient cohort. In addition to randomized controlled trials to demonstrate the efficacy and safety of the different interventional treatment modalities, it is important to continue to generate registry data to eventually initiate a paradigm shift.