Perioperative outcomes and risk factors following common femoral endarterectomy: A multicenter retrospective study

Common femoral endarterectomy (CFE) remains essential in the endovascular era for treating common femoral artery disease and enabling hybrid revascularization. Despite its widespread use, contemporary data on outcomes and risk factors are limited. This retrospective multicenter study analyzed 150 consecutive CFE procedures performed at 2 Korean centers between January 2017 and February 2024. The primary endpoints were 6-month all-cause mortality and 3-month local complications. Univariate logistic regression was performed to identify potential risk factors. Although CFE is technically straightforward, it has meaningful perioperative risks, particularly in patients with chronic kidney disease, high American Society of Anesthesiologists scores, or chronic limb-threatening ischemia (CLTI). These findings underscore the importance of careful patient selection and perioperative optimization and highlight the need for vigilant postoperative monitoring even for this commonly performed procedure. The cohort included 150 limbs from 132 patients (mean age 72.2 ± 9.8 years; 72.7% male). Clinical presentations included claudication (45.3%), chronic limb-threatening ischemia (CLTI; 36.7%), acute limb ischemia (12.7%), and access-related indications (5.3%). Combined procedures were performed in 86.7% of the patients. The 6-month mortality rate was 6.7% (10/150), and 3-month local complications occurred in 7.3% of patients (11/150). The significant risk factors for mortality according to the univariate analysis included chronic kidney disease (odds ratio [OR] 4.19; 95% confidence interval [CI] 1.13-15.49; P = .037), an American Society of Anesthesiologists score ≥ 4 (OR 7.75; 95% CI 2.02-29.73; P = .005), and CLTI (OR 4.47; 95% CI 1.11-18.08; P = .038). A body mass index > 25 kg/m2 was significantly associated with local complications (OR 4.01, 95% CI 1.15-14.02; P = .031). Subgroup analysis revealed no significant difference in outcomes between isolated CFE (n = 36) and combined CFE (n = 114).