Full Endovascular vs Hybrid Repair of Common Femoral Artery Associated with Ipsilateral Concomitant Arterial Lesions in Septuagenarians Patients.
TL;DR
In septuagenarian patients, full endovascular repair of the CFA and ipsilateral concomitant lesions was associated with mid-term outcomes similar to those of hybrid surgery, while reducing hospital length of stay and perioperative complications.
Abstract
Purpose
Multilevel lower limb peripheral artery disease remains a significant healthcare challenge, particularly in an aging population. Endovascular procedures have gained increasing interest, especially in elderly patients with significant comorbidities. The aim of this study was to compare full endovascular treatment (ENDO) versus hybrid repair (HYR) for common femoral artery (CFA) lesions when combined with concomitant lower limbs lesions in septuagenarian's patients.
Methods
Between June 2016 and June 2024, 186 patients aged ≥ 70 were treated for CFA occlusive disease with iliac or femoropopliteal lesions (102 hybrid, 84 endovascular). After propensity score matching, 54 patients remained in each group. The primary endpoint was the primary sustained clinical improvement. Secondary outcomes included overall survival, major adverse limb events (MALE), primary patency, and target lesion revascularization (TLR).
Results
Overall, CFA lesions were classified as Azema I (6%), Azema II (23%), and Azema III (71%). Baseline clinical and demographic characteristics were well balanced between the groups except for age and concomitant treated lesions. ENDO group was slightly older (78 +/- 5 vs 75 +/- 5 years, p < 0.001) and had more femoropopliteal lesions (57% vs 33%; p < 0.001). Intermittent claudication was the most common clinical presentation (HYR group: 65%; ENDO group: 59%; p=0.35). The mean duration of hospitalization was significantly lower in the stenting group (5 ± 1.5 days versus 10 ± 2.5 days; p<0.001). The 30-day cumulative complication rate was higher in the hybrid group (6% vs 19%, p=0.07). At 24-months, primary sustained clinical improvement was similar between the groups (85% vs 91%, p=0.1). No significant differences were observed in global survival, MALE, primary patency, or freedom from TLR.
Conclusion
In septuagenarian patients, full endovascular repair of the CFA and ipsilateral concomitant lesions was associated with mid-term outcomes similar to those of hybrid surgery, while reducing hospital length of stay and perioperative complications. Full endovascular treatment could nonetheless be considered a valid alternative to hybrid procedures in septuagenarian patients, especially those at high surgical risk, pending confirmation in more homogeneous, prospective cohorts.