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Published on: February 27, 2017
Utilization of Bovine Pericardium Patch During Common Femoral Endarterectomy
Dóra Zoé Zatykó1, Enikő Pomozi1, Dániel Pál1
1Department of Vascular and Endovascular Surgery, Semmelweis University Heart and Vascular Centre, 1122 Budapest, Hungary.
Insights
Bovine pericardium patch (BPP) closure after femoral artery endarterectomy (FE) shows good survival and reintervention rates. However, critical limb ischemia and bacterial infections increase surgical site infection risk.
Area of Science:
- Vascular Surgery
- Surgical Materials
- Wound Healing
Background:
- Common femoral endarterectomy (CFE) is a frequent open arterial procedure.
- The optimal material for arteriotomy closure in CFE remains debated.
- Bovine pericardium patch (BPP) is a potential option for femoral artery endarterectomy (FE) closure.
Purpose of the Study:
- To evaluate the efficacy and safety of bovine pericardium patch (BPP) in femoral artery bifurcation endarterectomy (FE).
- To assess outcomes including survival, reintervention, amputation, and surgical site infection (SSI) rates.
Main Methods:
- Retrospective analysis of 200 consecutive FE procedures using BPP.
- Data collected on demographics, comorbidities, surgical details, and outcomes.
- Primary endpoints: overall survival, reintervention-free survival, amputation-free survival; Secondary endpoint: SSI incidence and risk factors.
Main Results:
- Two-year survival was 69.3%; reintervention-free survival was 77.5%; amputation-free survival was 87.4%.
- Surgical site infection (SSI) occurred in 16% of patients, with higher risk in critical limb ischemia (CLI).
- MRSA, Escherichia coli, and Pseudomonas aeruginosa significantly increased SSI risk (OR 16.1, p < 0.001).
Conclusions:
- Bovine pericardium patch (BPP) utilization in FE yields favorable patency and survival, even in high-risk patients.
- Critical limb ischemia (CLI) and bacterial colonization are significant risk factors for SSI.
- Perioperative infection prevention and management of comorbidities are crucial for improving patient outcomes.
Abstract:
Background/Objectives: Common femoral endarterectomy (CFE) is one of the most frequent open arterial surgical procedures. The ideal material to close the arteriotomy is equivocal. This study aims to evaluate the efficacy and safety of bovine pericardium patch (BPP) utilization in femoral artery bifurcation endarterectomy (FE). Methods: A single-center, retrospective study was conducted, involving 200 consecutive FE procedures performed between November 2019 and December 2022. Clinical data, including demographics, comorbidities, surgical details, and outcomes, were collected from institutional records. The primary endpoints were overall survival, reintervention-free survival, and amputation-free survival. Secondary endpoints included the incidence of surgical site infection (SSI) and its associated risk factors. Logistic regression models were used to identify predictors of SSI, adjusting for confounders such as age, smoking, comorbidities, and bacterial colonization. Results: The median age of the cohort was 68 (SD ± 9.70) years, and 66% were male. The median follow-up period was 1010 (SD ± 471.47) days. Thirty-day survival was 91%, and 2 year survival was 69.3%, with cardiovascular events and cancer being the leading causes of death. Reintervention-free survival was 94.7% at 30 days and 77.5% at 2 years, while amputation-free survival was 94.3% at 30 days and 87.4% at 2 years. SSI requiring surgery occurred in 16% of patients, with a higher risk observed in patients with critical limb ischemia (CLI) compared to those with claudication. The presence of pathogens such as MRSA, Escherichia coli, and Pseudomonas aeruginosa (OR 16.1, p < 0.001) was significantly associated with SSI. Previous groin surgery did not affect SSI incidence. Conclusions: BPP utilization in FE provides favorable patency and survival outcomes, even in a high-risk patient population with significant comorbidities. CLI and bacterial colonization increased the risk of SSI. Perioperative infection prevention strategies and management of systemic comorbidities are essential to improve patient outcomes.
