Incidence and Survival Outcome Following Femoral Artery Reconstruction During Endovascular Abdominal Aortic Aneurysm Repair

Abstract

Background: Planned or unplanned reconstruction of the common femoral artery (femoro-femoral crossover and/or patch closure) may be required following endovascular abdominal aortic aneurysm repair (EVAR) stent graft deployment for arterial closure or maintenance of limb perfusion. The aim of this study was to examine the incidence of common femoral artery reconstruction (FAR) following EVAR and examine the effect on patient survival. Methods: A total of 178 patients undergoing EVAR were studied retrospectively. Results: In all, 31 patients (17.4%) underwent FAR; 16 (51.6%) femoro-femoral crossover, and 15 (48.4%) endarterectomy and patch closure. All cause survival in patients undergoing FAR was significantly poorer than those undergoing direct closure (P = .010).A total of 3 factors: the need for FAR (hazard ratio [HR] = 0.435, P = .006), chronic obstructive pulmonary disease ([COPD] HR = 0.424, P = .002), and abdominal aortic aneurysm (AAA) size (HR = 1.414, P = .005) were significantly and independently associated with survival on forward conditional analysis. Conclusions: Femoral artery reconstruction was performed in almost 1 in 5 patients undergoing EVAR and associated with decreased survival. Multidisciplinary teams should be aware of these findings when planning EVAR, especially in borderline candidates.

Keywords

abdominal aortic aneurysm survival operative procedures femoral arteries endarterectomy

Get full access to this article

View all access options for this article.

References

Lovegrove RE , Javid M. , Magee TR , Galland RB A meta-analysis of 21,178 patients undergoing open or endovascular repair of abdominal aortic aneurysm. Br J Surg. 2008 ;95(6):677-684.

Rayt HS , Sutton AJ , London NJ , Sayers RD , Bown MJ A systematic review and meta-analysis of endovascular repair (EVAR) for ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg. 2008;36(5):536-544.

United Kingdom EVAR Trial Investigators. Greenhalgh RM , Brown LC , Powell JT , Thompson SG , Epstein D. , Schulpher MJ Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med. 2010;362(20):1863-1871.

Hopkins R. , Bowen J. , Campbell K. , et al. Effects of study design and trends for EVAR versus OSR. Vasc Health Risk Manag. 2008;4(5):1011-1022.

Heredero AF , Stefanov S. , del Moral LR , et al. Long-term results of femoro-femoral crossover bypass after endovascular aortouniiliac repair of abdominal aortic and aortoiliac aneurysms. Vasc Endovascular Surg. 2008;42(5):420-426.

Slappy AL , Hakaim AG , Oldenburg WA , Paz-Fumagalli R. , McKinney JM Femoral incision morbidity following endovascular aortic aneurysm repair. Vasc Endovascular Surg. 2003;37(2): 105-109.

Fowkes F. , Leng GC Bypass surgery for chronic lower limb ischaemia. Cochrane Database Syst Rev. 2008;16(2):CD002000.

Kaplan EL , Meier P. Non-parametric estimation from incomplete observations. J Am Stat Assoc. 1958;58(17):457-481.

Cox DR Regression models and life tables. J Royal Stat Soc. 1972;B(34):187-200.

10.

Abedi NN , Davenport DL , Xenos E. , Sorial E. , Minion DJ , Endean ED Gender and 30-day outcome in patients undergoing endovascular aneurysm repair (EVAR): an analysis using the ACS NSQIP dataset. J Vasc Surg. 2009;50(3):486-491.

11.

Beck AW , Goodney PP , Nolan BW , Likosky DS , Eldrup-Jorgensen J. , Cronenwett JL Predicting 1-year mortality after elective abdominal aortic aneurysm repair . J Vasc Surg. 2009;49(4):838-843.

12.

Berge C. , Haug ES , Romundstad PR , Lange C. , Myhre HO Improved long-term survival following infrarenal abdominal aortic aneurysm repair. Scand Cardiovasc J. 2008;42(5):354-359.

13.

Boult M. , Maddern G. , Barnes M. , Fitridge R. Factors affecting survival after endovascular aneurysm repair: results from a population based audit. Eur J Vasc Endovasc Surg. 2007;34(2): 156-162.

14.

Korhonen SJ , Ylonen K. , Biancari F. , Heikkinen M. , Salenius JP , Lepantalo M. Glasgow Aneurysm Score as a predictor of immediate outcome after surgery for ruptured abdominal aortic aneurysm. Br J Surg. 2004;91(11):1449-1452.

15.

Samy AK , Murray G. , MacBain G. Glasgow aneurysm score. Cardiovasc Surg. 1994 ;2(1):41-44.

16.

Black SA , Carrell TW , Bell RE , Waltham M. , Reidy J. , Taylor PR Long-term surveillance with computed tomography after endovascular aneurysm repair may not be justified. Br J Surg. 2009 ; 96(11):1280-1283.

17.

Prinssen M. , Verhoeven EL , Buth J. , et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2004;351(16):1607-1618.

18.

United Kingdom Evar Trial Investigators. Greenhalgh RM , Brown LC , Powell JT , Thompson SG , Epstein D. , Schulpher MJ Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet. 2005;365(9478):2179-2186.

19.

United Kingdom Evar Trial Investigators. Greenhalgh RM , Brown LC , Powell JT , Thompson SG , Epstein D. , Schulpher MJ Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomised controlled trial. Lancet. 2005;365(9478):2187-2192.

20.

Fowkes FG , Housley E. , Cawood EH , Macintyre CC , Ruckley CV , Prescott RJ Edinburgh Artery Study : prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population. Int J Epidemiol. 1991 ;20(2):384-392.

21.

Leng GC , Lee AJ , Fowkes FG , et al. Incidence, natural history and cardiovascular events in symptomatic and asymptomatic peripheral arterial disease in the general population. Int J Epidemiol. 1996;25(6):1172-1181.

22.

Sprengers RW , Janssen KJ , Moll FL , Verhaar MC , van der GY Prediction rule for cardiovascular events and mortality in peripheral arterial disease patients: data from the prospective Second Manifestations of ARTerial disease (SMART) cohort study. J Vasc Surg. 2009;50(6):1369-1376.

23.

Rothwell PM , Coull AJ , Silver LE , et al. Population-based study of event-rate, incidence, case fatality, and mortality for all acute vascular events in all arterial territories (Oxford Vascular Study). Lancet. 2005;366(9499):1773-1783.

24.

Jean-Baptiste E. , Batt M. , Azzaoui R. , Koussa M. , Hassen-Khodja R. , Haulon S. A comparison of the mid-term results following the use of bifurcated and aorto-uni-iliac devices in the treatment of abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2009; 38(3):298-304.

25.

Malkawi AH , Hinchliffe RJ , Holt PJ , Loftus IM , Thompson MM Percutaneous access for endovascular aneurysm repair: a systematic review . Eur J Vasc Endovasc Surg. 2010;39(6):676-682.

26.

Zipfel B. , Buz S. , Dusterhoft V. , Hetzer R. Initial experience with abdominal aneurysm repair using the E-vita abdominal stent-graft: a single-center study. J Endovasc Ther. 2009;16(5): 577-589.