Endovascular treatment of the common femoral artery in the Vascular Quality Initiative

Abstract

Objective: Endovascular interventions of the common (CFA) and deep (DFA) femoral arteries are becoming more common. However, there is very little published data for guidance. Our objective was to analyze practice patterns and outcomes from these interventions.

Methods: The Vascular Quality Initiative (2010-2015) was queried for all endovascular interventions of the CFA and DFA. Cases that were emergent or for acute limb ischemia were excluded. Those with isolated CFA with or without DFA treatment were analyzed.

Results: There were 1014 patients that had either an isolated CFA intervention (946) with or without a DFA intervention (68). Average age of this isolated cohort was 67.4 ± 10.8 years, and 59% were male. Indications were claudication (67%), rest pain (16.3%), and tissue loss (16.7%). Periprocedural complications were access site hematoma (5.2%), arterial dissection (2.9%), distal embolization (0.7%), access site stenosis/occlusion (0.5%), and arterial perforation (0.6%). Thirty-day mortality was 1.6%. Survival was 92.9% at 1 year and 87.2% at 3 years. Amputation-free survival, freedom from loss of patency or death, and reintervention-free survival were 93.5%, 83%, and 87.5% at 1 year, respectively, by Kaplan-Meier analysis. Multivariable predictors of mortality were tissue loss, chronic obstructive pulmonary disease (COPD), end-stage renal disease, urgent case, and age, whereas aspirin use and non-Caucasian race were protective. Tissue loss, rest pain, COPD, end-stage renal disease, stent use, nonambulatory status, and female sex were predictive of major amputation whereas aspirin use, P2Y12 antagonist use, statin use, and initial technical success were protective. Tissue loss, case urgency and nonambulatory status predicted patency loss or death. Tissue loss, COPD, stent use, and history of prior bypass predicted reintervention.

Conclusions: Endovascular interventions of the CFA/DFA have a low rate of periprocedural morbidity and mortality. One-year patency is lower than historically observed for CFA endarterectomy. Stent use is associated with reinterventions and amputation. Longer-term analysis is needed to better assess durability.