Iliofemoral endarterectomy and stenting improves mid-term patency for advanced aortoiliac disease with concomitant common femoral disease

Authors

Nathan J. Reinert, Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
Francis J. Caputo, Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
Natasha Ahuja, Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
Alice Alexander, Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
James Bena, Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
Andrew Smith, Department of Vascular Surgery, Heart and Vascular Surgery Institute,Bridgeport Hospital, Bridgeport, CT, USA.
Ali Khalifeh, Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
Courtney Hanak, Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
Ravi Ambani, Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
Nicholas G. Hoell, Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
Levester Kirksey, Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
Sean P. Lyden, Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
Jon G. Quatromoni, Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.

Document Type

Article

Publication Title

Vascular

Abstract

ObjectiveCombined iliofemoral endarterectomy and iliac stenting (IFE + S) is a proven surgical approach for TransAtlantic Inter-society Consensus (TASC) C and D aortoiliac occlusive disease (AIOD). Iliac stenting alone (ISA) may be an attractive, minimally invasive option in select cases; however, untreated moderate-to-severe common femoral disease may threaten iliac stent patency and limit symptom improvement. This study evaluates the mid-term patency rates after IFE + S versus ISA for TASC C and D AIOD as well as the rate of interval femoral endarterectomies in those who underwent ISA.MethodsThis is a retrospective, single-center analysis of patients from 2011 to 2018 with TASC C or D AIOD and concomitant femoral artery stenosis of >50% who underwent IFE + S or ISA. Baseline lesion and patient characteristics such as TASC classification, degree of stenosis, calcification severity, lesion length, and baseline ankle-brachial index (ABI) were collected. Primary, primary-assisted, and secondary patency rates were calculated over three years with Kaplan-Meier estimates. The rate of interval femoral endarterectomies in the ISA cohort was measured at the same time endpoint.ResultsOf the 78 limbs identified, 64 (82.1%) underwent IFE + S and 14 (17.9%) underwent ISA. No significant differences in aortoiliac or femoral lesion characteristics existed. Iliac stent primary patency was significantly improved in the IFE + S group at three years [85.1% versus 55.6%, HR 3.96 (95% CI 1.54, 10.2, p = .004)]. Primary-assisted and secondary patency rates were not significantly different. Five (35.7%) patients in the ISA cohort required an interval femoral endarterectomy for ischemic symptoms over the three-year endpoint. In select patient populations with concomitant TASC C or D AIOD and common femoral artery disease, IFE + S may provide improved mid-term primary stent patency when compared to ISA. A subset of patients who undergo ISA may require future femoral endarterectomies for ischemic symptoms.

First Page

17085381251377294

DOI

10.1177/17085381251377294

Publication Date

9-4-2025

Recommended Citation

Reinert, Nathan J.; Caputo, Francis J.; Ahuja, Natasha; Alexander, Alice; Bena, James; Smith, Andrew; Khalifeh, Ali; Hanak, Courtney; Ambani, Ravi; Hoell, Nicholas G.; Kirksey, Levester; Lyden, Sean P.; and Quatromoni, Jon G., "Iliofemoral endarterectomy and stenting improves mid-term patency for advanced aortoiliac disease with concomitant common femoral disease" (2025). Surgery. 274.
https://scholar.bridgeporthospital.org/surgery/274

Identifier

40906943 (pubmed); 10.1177/17085381251377294 (doi)