A Novel Angiography Scoring System Predicts Improvement After Isolated Common Femoral Endarterectomy With Profundaplasty.

Abstract Introduction Numerous angiography-based peripheral arterial disease classification schemes have been developed to stratify severity of preoperative patient disease, but few studies have correlated angiography-based anatomic classification schemes to postoperative outcomes. This study examined whether a proposed pre-operative angiography scoring system was predictive of outcomes after isolated common femoral endarterectomy with profundaplasty (CFEP). Methods A retrospective review was conducted of patients treated with isolated CFEP for claudication and/or rest pain at a single institution from 2016-19. Pre-operative angiograms were assessed quantitatively by four blinded surgeons across three domains: profunda stenosis, profunda disease length, and outflow disease severity. Table 1 describes the proposed angiography scoring system. Internal consistency reliability of rater scores was calculated using Cronbach alpha. Outcomes included clinical improvement, further interventions, major amputations, mortality, and mean increase in ankle-brachial index (ABI) at 30 days and six months. McNemar tests, between-group t-tests, Pearson correlations and linear regression were used. Results Clinical Outcomes 88% of patients (n=22) had clinical improvement at 30 days; the remaining 12% of patients (n=3) required further interventions. One patient (4%) required major amputation between 30 days and six months for recurrence of rest pain that had initially resolved after isolated CFEP. There was 0% mortality during the study period. Mean ABI increased by 0.15 ± 0.21 at 30 days, and by 0.06 ± 0.21 at six months. Angiography Scoring System Profunda stenosis score was associated with clinical improvement at six months (p=0.04). A profunda stenosis score of ≥ 2.6 was strongly associated with six-month clinical improvement (64% of those ≥ 2.6 improved, versus 15% of those Conclusion This institutional angiography scoring system successfully predicts clinical improvement following CFEP.  Higher profunda stenosis and profunda disease length scores were most predictive of operative success within six months. Future validation studies will investigate these outcomes in a larger population, and over a longer period.