The natural history of isolated common femoral endarterectomy for chronic limb-threatening ischemia

Area of Science:

• Vascular Surgery
• Peripheral Artery Disease
• Limb Salvage

Background:

• Common femoral artery (CFA) occlusive disease causes severe lower extremity ischemia.
• Isolated common femoral endarterectomy (CFE) is effective for lifestyle-limiting claudication but questioned for chronic limb-threatening ischemia (CLTI) due to lack of direct plantar arch flow.

Purpose of the Study:

• To evaluate the natural history of CLTI patients treated with isolated CFE without additional infrainguinal revascularization.
• To assess the safety and effectiveness of isolated CFE as primary therapy for CLTI.

Main Methods:

• Retrospective review of consecutive CFEs for CLTI (2014-2021).
• Analysis of patient demographics, limb/anatomical staging (Wound, Ischemia, foot Infection [WIfI] and Global Limb Anatomic Staging System), and clinical outcomes.
• Assessment of limb-specific and survival-related endpoints.

Main Results:

• Fifty-eight CLTI patients (mean age 74, 90% smokers) underwent isolated CFE.
• High prevalence of comorbidities (diabetes 52%, CAD 55%) and advanced limb threat (64% tissue loss, 68% WIfI stage 3-4).
• Median follow-up of 17 months showed low reintervention (12%) and amputation (2%) rates; WIfI stage 4 predicted need for infrainguinal bypass (P=.034).

Conclusions:

• Isolated CFE is a safe and effective primary treatment for carefully selected CLTI patients.
• The index limb's stage (WIfI) is a significant predictor for requiring subsequent infrainguinal revascularization in this complex population.