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Surgical Treatment of Femoral Artery Bifurcation Without Material: Technique and Follow-Up

      Background

      Complete eversion of the femoral tripod is interesting to reduce clinical consequences of wound infection, in particular for patients at a high risk (e.g., obese, diabetics, cancer). Experience and follow-up of this technique are scarce. The different technical possibilities and results are reported here.

      Methods

      A single-center prospective study including patients operated on for femoral occlusive lesions using eversion of the common femoral artery and its bifurcation. Clinical and imaging preoperative data, surgical technique, and follow-up are detailed.

      Results

      Thirty five patients (37 limbs) have been included between June 2014 and April 2016. The mean Rutherford index was 3.6 and 65% of the patients were claudicants. Lesions were limited to the common femoral artery in 14 (38%) of the cases and spread to the superficial femoral artery in 2 (7%) and to the 3 branches in 21 (57%) of the cases, respectively. Postoperatively, one death, one major amputation, and 3 reinterventions were noted, resulting in an 8% rate of major complications. The mean follow-up was 37 months. At this time, 11 major adverse cardiovascular events, 9 deaths, and no additional major amputation were noted. The mean Rutherford index was 1.7 (P < 0.001) and 3 reinterventions were necessary (one for septic occlusion at 3 months and 2 for restenosis at 12 and 42 months), translating into primary and secondary patency rates of 93.3% and 96.1%, respectively.

      Conclusions

      This work further confirms that eversion of the femoral tripod is safe and effective. This experience adds to the existing body of the literature and describes alternative techniques of eversion. The technique should be considered when treating patients at a high risk of postoperative infection.
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      References

        • Cardon A.
        • Aillet S.
        • Jarno P.
        • et al.
        [Endarteriectomy of the femoral tripod: long-term results and analysis of failure factors].
        Ann Chir. 2001; 126: 777-782
        • Kang J.L.
        • Patel V.I.
        • Conrad M.F.
        • et al.
        Common femoral artery occlusive disease: contemporary results following surgical endarterectomy.
        J Vasc Surg. 2008; 48: 872-877
        • Ballotta E.
        • Gruppo M.
        • Mazzalai F.
        • et al.
        Common femoral artery endarterectomy for occlusive disease: an 8-year single-center prospective study.
        Surgery. 2010; 147: 268-274
        • Wieker C.M.
        • Schönefeld E.
        • Osada N.
        • et al.
        Results of common femoral artery thromboendarterectomy evaluation of a traditional surgical management in the endovascular era.
        J Vasc Surg. 2016; 64: 995-1001
        • Perou S.
        • Pirvu A.
        • Morel J.
        • et al.
        Femoral bifurcation endarterectomy with transection-eversion of the superficial femoral artery: technique and results.
        Ann Vasc Surg. 2018; 53: 177-183
        • Lau H.
        • Cheng S.W.
        • Hui J.
        Eighteen-year experience with femoro-femoral bypass.
        Aust N Z J Surg. 2000; 70: 275-278
        • Nguyen B.-N.
        • Amdur R.L.
        • Abugideiri M.
        • et al.
        Postoperative complications after common femoral endarterectomy.
        J Vasc Surg. 2015; 61: 1489-1494.e1
        • Greenblatt D.Y.
        • Rajamanickam V.
        • Mell M.W.
        Predictors of surgical site infection after open lower extremity revascularization.
        J Vasc Surg. 2011; 54: 433-439
        • Swinnen J.
        • Chao A.
        • Tiwari A.
        • et al.
        Vertical or transverse incisions for access to the femoral artery: a randomized control study.
        Ann Vasc Surg. 2010; 24: 336-341
        • Nasr B.
        • Kaladji A.
        • Vent P.-A.
        • et al.
        Long-term Outcomes of common femoral artery stenting.
        Ann Vasc Surg. 2017; 40: 10-18
        • Boufi M.
        • Ejargue M.
        • Gaye M.
        • et al.
        Systematic review and meta-analysis of endovascular versus open repair for common femoral artery atherosclerosis treatment.
        J Vasc Surg. 2021; 73: 1445-1455
        • Esposito A.
        • Menna D.
        • Baiano A.
        • et al.
        Eversion endarterectomy of the femoral bifurcation: technique, results and potential advantages.
        Ann Vasc Surg. 2020; 66: 580-585
        • Mirmehdi I.
        • Rigamer M.
        • Nguyen A.
        • et al.
        Experience with eversion endarterectomy of the common femoral artery with comparison to standard endarterectomy with patch.
        Ann Vasc Surg. 2020; 63: 204-208
        • Dufranc J.
        • Palcau L.
        • Heyndrickx M.
        • et al.
        Technique and results of femoral bifurcation endarterectomy by eversion.
        J Vasc Surg. 2015; 61: 728-733
        • Kechagias A.
        • Ylönen K.
        • Biancari F.
        Long-term outcome after isolated endarterectomy of the femoral bifurcation.
        World J Surg. 2008; 32: 51-54
        • Malgor R.D.
        • Ricotta J.J.
        • Bower T.C.
        • et al.
        Common femoral artery endarterectomy for lower-extremity ischemia: evaluating the need for additional distal limb revascularization.
        Ann Vasc Surg. 2012; 26: 946-956
        • Halpin D.
        • Erben Y.
        • Jayasuriya S.
        • et al.
        Management of isolated Atherosclerotic stenosis of the common femoral artery: a review of the literature.
        Vasc Endovascular Surg. 2017; 51: 220-227
        • Al-Khoury G.
        • Marone L.
        • Chaer R.
        • et al.
        Isolated femoral endarterectomy: impact of SFA TASC classification on recurrence of symptoms and need for additional intervention.
        J Vasc Surg. 2009; 50: 784-789
        • Chang R.W.
        • Goodney P.P.
        • Baek J.H.
        • et al.
        Long-term results of combined common femoral endarterectomy and iliac stenting/stent grafting for occlusive disease.
        J Vasc Surg. 2008; 48: 362-367
        • Derksen W.J.M.
        • Gisbertz S.S.
        • Hellings W.E.
        • et al.
        Predictive risk factors for restenosis after remote superficial femoral artery endarterectomy.
        Eur J Vasc Endovasc Surg. 2010; 39: 597-603
        • Nasr B.
        • Della Schiava N.
        • Thaveau F.
        • et al.
        The common femoral artery bifurcation lesions: clinical outcome of simple versus complex stenting techniques - an analysis based on the TECCO trial.
        Ann Vasc Surg. 2020; 64: 2-10