Mid-term outcomes of complex TASC D lesions involving the common femoral artery bifurcation

ObjectiveThe aim of this study was to evaluate the efficacy of hybrid therapy and endovascular therapy in the treatment of complex femoropopliteal Trans-Atlantic Inter-Society Consensus II D（TASC D） lesions involving the common femoral artery bifurcation.MethodsPatients with complex femoropopliteal TASC D lesions involving the bifurcation of the common femoral artery for atherosclerotic disease were retrospectively analyzed in our institution from July 2018 to July 2023. Patients were followed up at 1, 3, 6, and 12 months and then every year. Clinical data were collected, including perioperative and follow-up information. The patency rate and the rate of freedom from clinically driven target lesion revascularization (CD-TLR) were measured using the Kaplan-Meier method.ResultsA total of 29 patients with 31 limbs (mean age 73.5 ± 11.5 years; 20 men) were included, divided into the hybrid therapy group (20 limbs, Group 1) and endovascular treatment group (11 limbs, Group 2). The mean follow-up time was 22.5 ± 16.3 months (1-60 months), and the mean length of the lesion was 31.5 ± 11.6 cm. Between these two groups, there was no statistically significant difference on baseline data <i>P</i>＞.05）. Group 1 had more long-segment chronic total occlusive (CTO) lesions than Group 2（<i>P</i>＜.05）. Totally, the 1- and 2-year patency rates of TASC D lesions were 74.6% and 55.2%, respectively; and the rate of freedom from CD-TLR was 81.2% and 70.3%, respectively. There was no statistically significant difference between these two groups in terms of 1-year primary patency rate（88.7% vs 100%） and freedom from CD-TLR of the common femoral artery (CFA) bifurcation（93.8% vs 100%）(<i>P</i>＞.05).ConclusionsFor common femoral artery bifurcation lesions, both hybrid endarterectomy and endovascular treatment demonstrate favorable clinical outcomes. While these findings support their use, definitive conclusions on comparative efficacy remain conditional on confirmation from large-scale, long-term studies.