For lesions in the common femoral artery, guidelines recommend surgical endarterectomy (TEA) as the gold standard. However, endovascular therapy (EVT) is an alternative option for these lesions.
In 2017 the first randomized study comparing TEA vs EVT was carried out, showing that EVT presents clinical benefits, though it does not replace surgical treatment as first treatment option in these cases.
The aim of this multicenter retrospective study was to compare EVT vs TEA clinical outcomes in the treatment of the common femoral artery.
Primary end point was loss of patency defined by doppler or ≥50% restenosis at 1-year followup. Secondary end point included periprocedural complications, hospitalization duration, endovascular reintervention, or surgery.
The study looked at 1193 patients, 761 treated with EVT and 432 with TEA; mean age was 74, and they were mostly men. Smoking and diabetes were the most frequent risk factors. Half of EVT patients received balloon angioplasty and 23% stenting. The use of ultravascular ultrasound was 59%, and the TEA group presented more complex lesions, high Rutherford 5 percentage and sub-occlusive lesions.
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Primary end point at one year was higher among TEA patients (82.3% vs 96.6%; P < 0.001). Restenosis risk was more frequent in EVT outpatients. However, hospitalized patients presented lower risk of restenosis compared against outpatients (statistically non-significant). Intervention free rate was higher in the TEA group (89.2% vs 97.0%; P = 0.002). However, there were no differences in survival and limb salvage. Perioperative complications were more frequent among surgical patients and hospital stay was longer in this group.
Conclusion
TEA showed efficacy and safety at one-year followup in this multicenter study, which is why this therapy continues to be the gold standard. Non-ambulatory patients might benefit from EVT.
Dr. Andrés Rodríguez.
Member of the Editorial board of SOLACI.org.
Original Title: 1-Year Outcomes of Thromboendarterectomy vs Endovascular Therapy for Common Femoral Artery Lesions CAULIFLOWER Study Results.
Reference: Tatsuya Nakama, MD et al J Am Coll Cardiol Intv 2022.
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