Institution: | 1. Department of Cardiology, Tokyo Bay Medical Center, Urayasu, Japan;2. Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan;3. Department of Cardiology, Heart & Vascular Institute, Funabashi Municipal Medical Center, Funabashi, Japan;4. Department of Vascular Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan;5. Department of Vascular Surgery, Matsuyama Red Cross Hospital, Ehime, Japan;6. Department of Cardiology, Tokyo Saiseikai Central Hospital, Tokyo, Japan |
Abstract: | BackgroundThromboendarterectomy (TEA) is the gold-standard treatment for common femoral artery (CFA). However, because of its low invasiveness and short hospitalization duration, CFA endovascular therapy (EVT) is performed in real-world practice. However, the clinical benefits and appropriate target population for CFA EVT remain unclear.ObjectivesThe aims of this study were to compare the clinical outcomes of TEA with those of EVT in patients with symptomatic CFA diseases and to identify the adequate target population for CFA EVT.MethodsA total of 1,193 consecutive patients who underwent EVT (n = 761) or TEA (n = 432) for CFA were identified and retrospectively reviewed from a registry of 66 institutions. The primary outcome was 1-year primary patency compared between EVT and TEA using propensity score matching. An interaction analysis was performed to explore the appropriate target population for CFA EVT.ResultsAfter propensity score matching, the 1-year primary patency rate was significantly higher in the TEA group (82.3% vs 96.6%; P < 0.001), whereas perioperative complications were more frequently observed in the TEA group (P = 0.047). Nonambulatory status attenuated the HR of EVT vs TEA for restenosis risk (P = 0.021), whereas the presence of nodular calcification significantly increased the HR (P = 0.040). In the EVT subgroup analysis for restenosis risk, stent use showed the lowest HR compared with plain balloon angioplasty and drug-coated balloon angioplasty (P < 0.001).ConclusionsTEA showed superior 1-year patency compared with EVT in a nationwide multicenter study. Nonambulatory status attenuated the superiority, whereas the presence of nodular calcification enhanced it. |