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Int J Angiol 2023; 32(02): 088-094
DOI: 10.1055/s-0042-1756622
Original Article

Pure Endovascular versus Hybrid Approach for Management of Iliofemoral Arterial Disease: A Randomized Controlled Trial

Ahmed A. Shaker
1   Department of Vascular and Endovascular Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
,
Ahmed H. Shehata
1   Department of Vascular and Endovascular Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
,
Khaled M. Alhindawy
1   Department of Vascular and Endovascular Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
,
Walid El Daly
1   Department of Vascular and Endovascular Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
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Abstract

Common femoral artery (CFA) atherosclerotic lesions currently remain one of the last limitations for adoption of endovascular repair as the first-line treatment, easy surgical accessibility, and, last but not least, favorable long-term outcomes, still making CFA disease treatment part of the surgical domain. In the last 5 years, improvement of the endovascular equipment and technical skills of the operators have led to an increase in percutaneous CFA procedures.

A single-center randomized prospective study of 36 symptomatic (Rutherford 2–4) CFA stenotic or occlusive lesions were included, and patients were randomized over two groups based on the management approach SUPERA versus hybrid technique.

Patients had a mean age 60.8 ± 8.2 years. Thirty-two (88.9%) patients reported improvement of the clinical symptoms, 28 (87.5%) patients had intact pulse postoperatively, and 28 (87.5%) had patent vessels. Follow-up showed that none developed reocclusion or restenosis during the period of follow-up. Comparison of difference in peak systolic velocity ratio (PSVR) among study groups showed that the hybrid technique had more reduction of PSVR postintervention compared to the SUPERA group with a p-value of < 0.0001.

Safety and feasibility of endovascular approach with the SUPERA stent to the CFA (no stent zone) has low incidence of postoperative morbidity and mortality in well experienced surgical hands.

Keywords

SUPERA - common femoral artery - endarterectomy - hybrid


Publication History

Article published online:
23 September 2022

© 2022. International College of Angiology. This article is published by Thieme.

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  • References

  • 1 Mahé G, Kaladji A, Le Faucheur A, Jaquinandi V. Internal iliac artery stenosis: diagnosis and how to manage it in 2015. Front Cardiovasc Med 2015; 2: 33
    CrossrefPubMedGoogle Scholar
  • 2 Wong G, Lahsaei S, Aoun J, Garcia LA. Management of common femoral artery occlusive disease: a review of endovascular treatment strategies and outcomes. Catheter Cardiovasc Interv 2019; 93 (03) 514-521
    CrossrefPubMedGoogle Scholar
  • 3 Starodubtsev V, Mitrofanov V, Ignatenko P. et al. Hybrid versus open surgical reconstruction for iliofemoral occlusive disease: a prospective randomized trial. Eur J Vasc Endovasc Surg 2022
    PubMedGoogle Scholar
  • 4 Azéma L, Davaine JM, Guyomarch B. et al. Endovascular repair of common femoral artery and concomitant arterial lesions. Eur J Vasc Endovasc Surg 2011; 41 (06) 787-793
    CrossrefPubMedGoogle Scholar
  • 5 Tao MJ, Gotra A, Tan KT, Eisenberg N, Roche-Nagle G, Mafeld S. SUPERA stenting in the common femoral artery: early experience and practical considerations. Vasc Endovascular Surg 2022; 56 (04) 357-368
    CrossrefPubMedGoogle Scholar
  • 6 Nelson PR, Powell RJ, Schermerhorn ML. et al. Early results of external iliac artery stenting combined with common femoral artery endarterectomy. J Vasc Surg 2002; 35 (06) 1107-1113
    CrossrefPubMedGoogle Scholar
  • 7 Gouëffic Y, Della Schiava N, Thaveau F. et al. Stenting or surgery for de novo common femoral artery stenosis. JACC Cardiovasc Interv 2017; 10 (13) 1344-1354
    CrossrefPubMedGoogle Scholar
  • 8 Silva JA, White CJ, Quintana H, Collins TJ, Jenkins JS, Ramee SR. Percutaneous revascularization of the common femoral artery for limb ischemia. Catheter Cardiovasc Interv 2004; 62 (02) 230-233
    CrossrefPubMedGoogle Scholar
  • 9 Baumann F, Ruch M, Willenberg T. et al. Endovascular treatment of common femoral artery obstructions. J Vasc Surg 2011; 53 (04) 1000-1006
    CrossrefPubMedGoogle Scholar