Femoral endarterectomy as a platform for simultaneous hybrid inflow and outflow revascularization: a retrospective single-center cohort study
This retrospective study demonstrates that femoral endarterectomy serves as a feasible, safe, and durable platform for simultaneous hybrid inflow and outflow revascularization in multilevel peripheral artery disease, achieving high patency rates without increasing severe complications compared to isolated procedures.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
The arteries that carry blood to the legs are like a complex network of pipes, and when the main pipe near the groin becomes clogged with hardened plaque, the flow of life-giving blood slows to a trickle. This blockage, known as peripheral artery disease, can cause severe pain when walking and, in its most dangerous form, threaten the very survival of the limb. For decades, surgeons have treated this specific blockage in the common femoral artery by cutting it open, scraping out the gunk, and sewing a patch over the hole to keep it wide open. This open surgery is considered the gold standard because it is incredibly durable, but it leaves a significant scar and requires a long recovery. Meanwhile, doctors have also developed less invasive ways to open blocked arteries using balloons and stents pushed through tiny punctures in the skin. The challenge arises when a patient has blockages in multiple places—both upstream toward the heart and downstream toward the foot. Traditionally, fixing all these problems might require multiple separate surgeries or a combination of a large open operation and a separate, blind needle stick in another part of the body to guide the tools.
A team of surgeons at Kyung Hee University Hospital in South Korea explored a clever way to combine these two worlds into a single, efficient session. They asked whether the open surgical site itself could serve as a secure gateway for the less invasive tools, eliminating the need for a second puncture elsewhere. By treating the open incision not just as a place to fix the local blockage, but as a central hub, they could reach both the arteries leading into the leg and those leading out of it through the same opening. Their goal was to see if this "hybrid" approach was safe, if it worked as well as the traditional method, and if it could handle the complex, multi-level disease that often afflicts older patients with diabetes and other health issues.
The researchers looked back at the medical records of 52 patients treated between 2010 and 2025. They divided these patients into two groups to understand the technique better. One group received the standard open surgery to clear the blockage in the groin artery alone. The other group, who had more extensive disease involving both the arteries feeding the leg and those draining it, received the hybrid treatment. For these patients, the surgeons performed the open scraping and patching of the groin artery, but before closing the incision completely, they threaded a sheath—a hollow tube—directly through the open patch. Through this tube, they could guide wires and catheters to inflate balloons or place stents in the blocked arteries above or below the groin, all while the patient was still on the operating table. This method allowed them to fix the entire road system for blood flow in one go, using the surgical site as a controlled entry point rather than relying on a separate, blind puncture in the opposite leg or a distant spot on the same leg.
The results showed that this approach was not only possible but highly effective. The open surgery site itself proved to be remarkably strong and long-lasting, staying open and unblocked in 94.2 percent of patients ten years after the operation. This durability was just as high in the group that used the site as a hub for additional procedures as it was in the group that had surgery alone. The surgeons found that adding the extra steps to treat the other blocked arteries did not make the surgery riskier or cause more serious complications like infections or the need for readmission. In fact, the only difference in safety was that the group with the more complex, multi-level disease had slightly fewer minor, temporary issues like mild wound pain or tingling, while the group with simpler disease had a higher rate of these minor, non-serious annoyances. The severe complications remained rare and equal between the two groups.
Beyond the safety of the surgery, the hybrid approach successfully improved blood flow for patients with the most severe symptoms, including those with chronic limb-threatening ischemia, a condition where the lack of blood flow puts the limb at risk of amputation. The patients saw a significant and immediate improvement in how well blood reached their feet, measured by a standard test called the ankle-brachial index. While the long-term success of the entire system depended heavily on the condition of the smaller arteries further down the leg, the main gateway created by the surgeons held firm. The study suggests that for patients with widespread blockages, using the open surgical site as a central hub allows doctors to clear the entire path for blood flow in a single session without compromising the strength of the repair or increasing the risk of harm.
The researchers were careful to note that their findings come from a specific group of patients and that the two groups they compared were not perfectly matched, as the hybrid group naturally had more severe disease. Because of this, the study serves as a proof of concept rather than a final verdict on which method is superior for everyone. It demonstrates that the technique is feasible and safe, offering a way to treat complex cases without the need for multiple separate procedures. The work highlights that the common femoral artery, often viewed simply as a local problem to be fixed, can instead be used as a strategic control point to manage the entire vascular system of the leg. This approach provides a tailored solution for patients who are often too frail for multiple surgeries, giving them a better chance at keeping their limbs and improving their quality of life.
Drowning in papers in your field?
Get daily digests of the most novel papers matching your research keywords — with technical summaries, in your language.