Femoral Endarterectomy: Risk Assessment and Considerations

The American College of Cardiology reports that common femoral endarterectomy (CFE) is associated with a potential for short-term morbidity, with minor or major complications occurring in 7.9% of patients 1
Local complications include lymphatic fistula (3.4%) 2
The need for procedure-related local revision is reported in 8.6% of patients 1
Primary patency rates of 78.5% at 7 years are observed following CFE 1

Comparison with Alternative Approaches

Meta-analytic data comparing CFE with endovascular interventions show similar risk of 30-day mortality and early reintervention 2
Endovascular approaches are associated with less procedural morbidity 1
Similar 1-year primary patency is observed between CFE and endovascular interventions 2
The need for late reintervention is similar between CFE and endovascular approaches 1

The American College of Cardiology recommends that selection of revascularization approach should be based on patient's goals 2
Anatomic findings should be considered when selecting a revascularization approach 1
Perioperative risk assessment is crucial in selecting patients for CFE 2
Anticipated benefit should be weighed against the risks of CFE 2
CFE should be reserved for patients who failed nonsurgical therapy 2
Favorable arterial anatomy is essential for durable results following CFE 2
Acceptable risk of perioperative adverse events should be considered when selecting patients for CFE 2
In cases where endovascular approaches may adversely affect profunda femoris artery pathways, open surgical endarterectomy is preferred 1