Stenting the Common Femoral Artery: Another Myth Debunked?

In vascular surgery circles, the common femoral artery (CFA) ranks only second to the carotid artery to exemplify the goodness and lasting qualities of reconstructive open surgery: “No endovascular therapy for this baby!”

And there are good arguments in support of such near-religion:

  1. Surgical approach to the CFA requires a short groin incision only;
  2. The procedure can be (relatively) easily performed under local anesthesia – except in markedly obese individuals;
  3. Blood flow into both the SFA (if patent) and the all-important profunda femoris can be restored, reliably and predictably, with endarterectomy and patch angioplasty;
  4. Placement of a metal stent device across the length of the CFA might compromise the profunda origin, and likely impede subsequent percutaneous puncture or access for vascular or cardiac intervention at a later date.

That said, there have been a number of recent publications and discussions on this subject that suggest these issues may not be written in stone after all. Perhaps CFA stenting is not such an “evil” thing to do, not always. And personally, I have encountered a few patients over the years—and one encounter last week in particular—where stenting of the SFA emerged as the natural and optimal thing to do; an elderly patient presented with a pre-occlusive CFA stenosis and profound limb ischemia, chronic occlusion of the profunda (which is admittedly rare), and a reconstituted patent SFA from its proximal segment on down. PTA/stenting worked like a charm!

Saying that absolutely dogmatic postures and attitudes are usually wrong is nothing crafty or new as it states the obvious. Nonetheless, the issues surrounding endovascular therapy for some CFA lesions are worth reconsidering. A tailored select approach is usually best, and I for one would welcome comments and feedback from vascular surgeons and others on this relatively new area that seems ripe for endovascular penetration.

_____________________________________________________________________________

Dr. Frank J Criado is a Board-Certified Vascular Surgeon and Endovascular Specialist at the Union Memorial Hospital-MedStar Health in Baltimore, Maryland – USA.

Dr. Criado is widely acknowledged to be a pioneer in endovascular therapy, with a 20-year + interventional experience. He has contributed extensively to the literature with more than 100 peer-reviewed published articles – mostly on various vascular and endovascular subjects, and Editor-in-Chief of Vascular Disease Management (VDM). He has also been active in clinical research, with a major focus on aortic stent-graft and carotid interventions, and endovascular technologies in general. He was the National Principal Investigator (P.I.) for the Medtronic Talent AAA clinical trials in the U.S., and a member of the Executive Committee for the Medtronic Valor Thoracic trial.

He is a founding member and immediate past President of the International Society of Endovascular Specialists (ISES), founder and current President of the endovascular surgery society of Latinamerica (CELA), and a member of all major U.S. and international vascular and endovascular societies. He is a Fellow of the American College of Surgeons (FACS) and of the Society of Vascular Medicine (FSVM), and a member of the Board of Directors of the Society for Vascular Surgery (SVS).

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Stenting the Common Femoral Artery: Another Myth Debunked?

In vascular surgery circles, the common femoral artery (CFA) ranks only second to the carotid artery to exemplify the goodness and lasting qualities of reconstructive open surgery: “No endovascular therapy for this baby!”

And there are good arguments in support of such near-religion:

  1. Surgical approach to the CFA requires a short groin incision only;
  2. The procedure can be (relatively) easily performed under local anesthesia – except in markedly obese individuals;
  3. Blood flow into both the SFA (if patent) and the all-important profunda femoris can be restored, reliably and predictably, with endarterectomy and patch angioplasty;
  4. Placement of a metal stent device across the length of the CFA might compromise the profunda origin, and likely impede subsequent percutaneous puncture or access for vascular or cardiac intervention at a later date.

That said, there have been a number of recent publications and discussions on this subject that suggest these issues may not be written in stone after all. Perhaps CFA stenting is not such an “evil” thing to do, not always. And personally, I have encountered a few patients over the years—and one encounter last week in particular—where stenting of the SFA emerged as the natural and optimal thing to do; an elderly patient presented with a pre-occlusive CFA stenosis and profound limb ischemia, chronic occlusion of the profunda (which is admittedly rare), and a reconstituted patent SFA from its proximal segment on down. PTA/stenting worked like a charm!

Saying that absolutely dogmatic postures and attitudes are usually wrong is nothing crafty or new as it states the obvious. Nonetheless, the issues surrounding endovascular therapy for some CFA lesions are worth reconsidering. A tailored select approach is usually best, and I for one would welcome comments and feedback from vascular surgeons and others on this relatively new area that seems ripe for endovascular penetration.

_____________________________________________________________________________

Dr. Frank J Criado is a Board-Certified Vascular Surgeon and Endovascular Specialist at the Union Memorial Hospital-MedStar Health in Baltimore, Maryland – USA.

Dr. Criado is widely acknowledged to be a pioneer in endovascular therapy, with a 20-year + interventional experience. He has contributed extensively to the literature with more than 100 peer-reviewed published articles – mostly on various vascular and endovascular subjects, and Editor-in-Chief of Vascular Disease Management (VDM). He has also been active in clinical research, with a major focus on aortic stent-graft and carotid interventions, and endovascular technologies in general. He was the National Principal Investigator (P.I.) for the Medtronic Talent AAA clinical trials in the U.S., and a member of the Executive Committee for the Medtronic Valor Thoracic trial.

He is a founding member and immediate past President of the International Society of Endovascular Specialists (ISES), founder and current President of the endovascular surgery society of Latinamerica (CELA), and a member of all major U.S. and international vascular and endovascular societies. He is a Fellow of the American College of Surgeons (FACS) and of the Society of Vascular Medicine (FSVM), and a member of the Board of Directors of the Society for Vascular Surgery (SVS).

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