Estrategias para el abordaje en la enfermedad estenooclusiva de la arteria femoral común. El rol de la evidencia científica  <span class="so-article-trans-title" dir="auto"> Translated title: Strategies for the management of steno-occlusive common femoral artery disease. The role of scientific evidence </span>

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Abstract

Resumen La lesión estenótica u oclusiva confinada a la arteria femoral común (AFC) es bastante infrecuente. Tradicionalmente, el tratamiento de referencia para esta entidad ha sido la endarterectomía femoral común (EFC). Este artículo tiene como objetivo realizar una revisión general de todas las estrategias terapéuticas actuales (cirugía abierta y abordajes endovasculares e híbridos) para el tratamiento de la lesión estenótica u oclusiva aislada de la AFC. Se realizó una búsqueda bibliográfica electrónica utilizando PubMed y Google. Se analizaron las ventajas y las desventajas de cada técnica de revascularización y se informó de los resultados. La EFC demostró un alto éxito técnico y excelentes tasas de permeabilidad. Sin embargo, se asoció con una morbilidad local significativa, mayor duración de la estancia hospitalaria y mayores costos médicos en comparación con las terapias endovasculares. Los enfoques terapéuticos mínimamente invasivos mostraron resultados aceptables con complicaciones locales menores, pero tasas de permeabilidad más bajas en comparación con la cirugía abierta. Esta revisión sugiere la necesidad de más estudios comparativos aleatorios para evaluar el verdadero balance beneficio-riesgo de la EFC tradicional frente a las nuevas terapias mínimamente invasivas para tratar lesiones aisladas de la AFC.

Translated abstract

Abstract Isolated atherosclerotic stenosis or occlusion of the common femoral artery (CFA) is rather uncommon. Traditionally, the standard of care of this entity has been the common femoral artery endarterectomy (CFE). This manuscript provides a general review of all the current therapeutical strategies (open surgery, endovascular and hybrid approaches) used to treat isolated CFA stenoses or occlusions. An electronic bibliographic search was performed on the Pubmed and Google databases. Advantages and disadvantages of each revascularization technique were analyzed and the outcomes reported. Common femoral endarterectomy (CFE) showed high technical success and excellent patency rates. However, it was associated with significantly local morbidities, longer lengths of stay and higher medical costs compared with endovascular therapies. Minimally invasive therapeutical approaches showed acceptable outcomes with minor local complications but lower patency rates compared to open surgery. Further randomized comparative studies are needed to assess the true benefit-risk ratio of traditional CFE vs new minimally invasive therapies for CFA disease.

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Hospital costs associated with surgical complications: a report from the private-sector National Surgical Quality Improvement Program.

P Taheri, L. Chen, F Khuri … (2004)

The National Surgical Quality Improvement Project (NSQIP) has reduced morbidity rates in Veterans Affairs Hospitals. As the NSQIP methods move to private-sector hospitals, funding responsibilities will shift to the medical center. The objective of the current study was to calculate hospital costs associated with postoperative complications, because reducing morbidity may offset the costs of using the NSQIP. Patient data were obtained from a single private-sector center involved in the NSQIP from 2001 to 2002 (n=1,008). Cost data were derived from the hospital's internal cost-accounting database (TSI; Transitions Systems Inc). Total hospital costs associated with both minor complications and major complications were calculated. Multiple linear regression was used to determine the cost of each type of complication after adjusting for patient characteristics. Rates of minor complications (6.3%, 64 events) and major complications (6.6%, 67 events) were similar. Median hospital costs were lowest for patients without complications (4,487 dollars) compared with those with minor (14,094 dollars) and major complications (28,356 dollars) (p<0.001). After adjusting for differences in patient characteristics, major complications were associated with an increase of 11,626 dollars (95% CI, 9,419 dollars to 13,832 dollars; p<0.001). Minor complications were not associated with increased costs in the adjusted analysis. Given the substantial costs associated with major postoperative complications, reducing morbidity may provide sufficient cost savings to offset the resources needed to participate in the private-sector expansion of the NSQIP.