Endovascular vs. Open Repair of the Common Femoral Artery - TECCO

Contribution To Literature:

The TECCO trial showed that stenting was superior to surgery at preventing revascularization-associated morbidity.

Description:

The goal of the trial was to evaluate stenting compared with surgery among patients with common femoral artery stenosis.

Study Design

  • Randomized
  • Parallel

Patients with common femoral artery stenosis were randomized to stenting (n = 56) versus surgery (n = 61). Patients in the stenting group received self-expanding stents; however, balloon-expandable stents could be used to treat ostial superficial femoral or deep femoral artery involvement. Patients in the surgery group underwent endarterectomy with or without a patch.

  • Total number of enrollees: 117
  • Duration of follow-up: 24 months
  • Mean patient age: 68 years
  • Percentage female: 16%
  • Percentage diabetics: 41%

Inclusion criteria:

  • Patients with atherosclerotic common femoral artery stenosis

Exclusion criteria:

  • Common femoral artery thrombosis, restenosis, or non-atheromatous lesions

Other salient features/characteristics:

  • Conversion to surgery occurred in three patients from the stenting group
  • In the stent group, 67.5% received a self-expanding stent, while 32.5% received a balloon expandable stent

Principal Findings:

The primary outcome, incidence of general/local complications (major adverse cardiac events, major amputations, hematoma, active bleeding, local infection, thrombosis, delayed wound healing, false aneurysm, or arteriovenous fistula), occurred in 12.5% of the stenting group versus 26% of the surgery group (p = 0.05).

Secondary outcomes:

  • Delayed wound healing: 0 vs. 16.4%, respectively for stenting versus surgery
  • Paresthesia: 0 vs. 6.5%, respectively for stenting versus surgery
  • There was no difference in target lesion revascularization, target extremity revascularization, or patency at 24 months between the two groups
  • In the stent group, one stent fracture was observed at 24 months

Interpretation:

Among patients with common femoral artery stenosis, surgical repair has been considered preferential due to concern from stenting across the hip joint. This trial revealed that stenting the common femoral artery with a self-expanding stent was feasible and associated with a lower rate of general/local complications at 30 days compared with surgery. This was driven by a lower frequency of delayed wound healing and paresthesia in the stent group. Future revascularization procedures appeared to be similar between the two groups up to 24 months. This study is an important step forward toward treating the common femoral artery with stenting and will need to be followed by future trials examining efficacy and safety outcomes beyond 24 months.

References:

Gouëffic Y, Schiava ND, Thaveau F, et al. Stenting or Surgery for De Novo Common Femoral Artery Stenosis. JACC Cardiovasc Interv 2017;10:1344-54.


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