Lesion Characteristics Associated with Loss of Primary Patency After Endovascular Therapy for Common Femoral Artery Lesions

Multicenter Registry of Common Femoral Artery Disease Treated With Endovascular Revascularization Using Interwoven Nitinol Stents: An Observational Retrospective Study

PURPOSE

Surgical thromboendarterectomy has been the gold standard treatment for common femoral artery (CFA) disease. However, endovascular therapy (EVT) is conducted in certain patients with CFA lesions because of multiple comorbidities. The interwoven nitinol stent (IWS) has been developed to prevent stent fracture. Thus, this study aimed to evaluate the feasibility of EVT using IWS for CFA lesions in clinical practice.

MATERIALS AND METHODS

This retrospective multicenter registry analyzed patients who had symptomatic lower-extremity artery disease due to CFA lesions and underwent EVT using IWS between 2019 and 2021. The primary endpoint was restenosis 2 years after EVT.

RESULTS

This study enrolled a total of 177 patients with 196 CFA lesions. The 2-year estimate of freedom from restenosis was 88.0%. The 2-year freedom rates from the target-lesion revascularization, major amputation, and all-cause death were 92.9%, 99.0%, and 75.2%, respectively. The clinical features significantly associated with restenosis risk were the reference vessel diameter (RVD, per 1.0 mm, hazard ratio [HR], 0.24 [0.08-0.70]; p=0.009), external iliac artery (EIA) involvement (HR=4.03 [1.56-10.4]; p=0.004), superficial femoral artery (SFA) involvement (HR=3.05 [1.00-9.25]; p=0.049), body mass index (BMI; per 1.0, HR=0.85 [0.73-0.99]; p=0.032), occlusion of deep femoral arteries (DFAs) at baseline (HR=7.89 [2.04-30.5]; p=0.003), and chronic limb-threatening ischemia (CLTI, HR=2.63 [1.02-6.78]; p=0.045). Their significant association was also confirmed by the random survival forest analysis. During a median follow-up of 12.0 months, guiding sheaths were inserted via CFAs implanted IWSs in 73 cases (37.2%), and no patients had cannulation-related complications, such as failed hemostasis, fracture of IWS, and stent occlusion.

CONCLUSIONS

Endovascular therapy using IWS in CFA lesions showed acceptable 2-year patency rates at 88.0% and might preserve the arterial access via the ipsilateral CFAs. Small RVD, involving EIA and SFA lesions, emaciation, occluded DFA, and CLTI are associated with poor 2-year patency rates following EVT, thus, IWS implantation in CFA lesions may be an option for patients unsuitable for surgical revascularization.

CLINICAL IMPACT

This retrospective multicenter registry enrolled 177 patients with 199 CFA lesions treated with EVT using interwoven nitinol stents, because surgical thromboendarterectomy was difficult due to their multiple comorbidities. The 2-year estimate of freedom from restenosis was acceptable at 88.0%. The 2-year freedom rate from major amputation was also high at 99.0%. Moreover, during a median follow-up of 12.0 months, guiding sheaths were inserted via CFAs implanted IWSs in 73 cases, and no patients had cannulation-related complications such as failed hemostasis, fracture of IWS, and stent occlusion.

Common Femoral Artery Curvature During Hip Flexion

PURPOSE

To assess the conformational changes of the common femoral artery (CFA) during hip joint flexion in patients without atherosclerosis.

METHODS

Patients who underwent digital subtraction angiography for suspicion of arterial endofibrosis between 2007 and 2011 were retrospectively searched. Angiographic images were analyzed by two independent readers. The CFA was divided into four segments of equal length, and the segment containing the folding point was noted. Segments 1 and 2 were located in the proximal half of the CFA and segments 3 and 4 in the distal half. Readers assessed the CFA angulation, located the arterial folding point, and classified the CFA curvature as harmonious, or as a moderate or severe plication.

RESULTS

Forty patients were included. The Lin concordance correlation coefficients, used to evaluate inter-observer variability, were 0.90 (95% CI [0.83; 0.96]), 0.96 (95% CI [0.93; 0.98]) and 0.96 (95% CI [0.94; 0.98]) for the measures of the CFA angle during flexion, of the length between the superficial circumflex iliac artery and the folding point, and of the length between the folding point and the femoral bifurcation, respectively. The CFA curvature was described as harmonious in 12 patients, moderate plication in 14 patients, and severe plication in 14 patients. The CFA folding point was located on segment 1, 2 and 3 in 6, 26 and 8 patients, respectively; no folding point was located on segment 4.

CONCLUSION

In these patients with non-atheromatous disease, hip flexion yielded most frequently a harmonious curvature or a moderate plication of the CFA.