Endarterectomy vs endovascular therapy for primary atheromatous CFA lesions

Aim: Advances in endovascular technology have challenged the gold standard of common femoral endarterectomy (CFE). Our study aims to assess technical success, primary patency rate and rate of morbidity and mortality following common femoral artery (CFA)  endovascular therapy, using either paclitaxel-coated balloons or stenting using interwoven nitinol stents, as compared to CFE.

Material and Methods: This is a randomized controlled trial. Patients were randomized into two groups: CFE and CFA endovascular therapy. Patients were followed up after 1, 6 and 12 months. Inclusion criteria included primary atheromatous hemodynamically significant CFA lesions, and presentation with Rutherford stages 3,4,5,6. Exclusion criteria included recurrent disease, non-atheromatous lesions, indication of bypass associated with CFA revascularization, and pregnancy. The primary outcome tested was the rate of morbidity and mortality and primary patency rate.

Results: The study included 120 patients, 64 underwent CFE and 56 received endovascular therapy. Technical success was achieved in all cases. The rate of wound and access site complications was lower in the endovascular group (7.1% vs. 18.6%), however this difference was statistically insignificant (p = 0.061). One-year primary patency rate was better in surgery group (100% vs. 64.6%, p < 0.001), but the limb salvage rate was similar in both groups. One-year primary patency rate was better with stents as compared with drug-coated balloon (DCB) (80.0% compared to 57.6%, p = 0.132), however limb salvage rate was similar with stenting and DCB.

Conclusion: Although CFE remains the first option in treating CFA disease, endovascular therapy of the CFA provides good patency rates and a limb salvage rate comparable with that of surgery.