Combined use of directional atherectomy and drug-coated balloon for the endovascular treatment of common femoral artery disease: immediate and one-year outcomes

Cioppa, Angelo; Stabile, Eugenio; Salemme, Luigi; Popusoi, Grigore; Pucciarelli, Armando; Iacovelli, Fortunato; Arcari, Antonella; Coscioni, Enrico; Trimarco, Bruno; Esposito, Giovanni; Tesorio, Tullio

doi:10.4244/eij-d-15-00187

Cited by 49 publications

(25 citation statements)

References 18 publications

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“…More recently, directional atherectomy in combination with DCB was used in 30 consecutive patients with common femoral artery stenosis or occlusion. 20 In this single-centre study, the procedural success was 100%. The authors noted a low rate of stenting (10%) and a very high patency rate of 97% at the follow-up investigation after where a technical success rate of 97% was achieved with a diameter stenosis reduction from 78.7% at baseline to 30.3% after atherectomy alone and with a low rate of peri-procedural complications, such as perforation (0%), catheter-related dissection (0.5%) and embolisation (2%).…”

Section: Directional Atherectomymentioning

confidence: 70%

The Role of Atherectomy in Peripheral Artery Disease: Current Evidence and Future Perspectives

Korosoglou¹,

Giuşcă²,

Andrassy³

et al. 2019

Vascular and Endovascular Review

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The prevalence of peripheral artery disease (PAD) has been rising consistently over the past few decades, along with increasing rates of type 2 diabetes. More than 200 million people are estimated to be affected by PAD worldwide. 1 Despite aggressive modifications of lifestyle and risk factors, and advances in the pharmacological management of patients with PAD using antiplatelet agents, statins, cilostazol, angiotensin-converting enzyme inhibitors, angiotensinreceptor blockers and low-dose anticoagulation with rivaroxaban, patients with PAD frequently require invasive procedures to improve the symptoms of claudication and prevent tissue damage or loss in those with critical limb ischaemia (CLI). 2 Due to recent technological advances in materials and devices for the endovascular treatment of PAD, a minimally invasive percutaneous approach is considered a first-choice strategy for the treatment of symptomatic patients and is given preference over older surgical options. According to current guidelines, endovascular therapy is the most favoured option for infrainguinal stenotic or occlusive lesions <25 cm, whereas open surgery may be associated with better longterm patency, especially when using saphenous vein grafts in patients with long occlusive lesions (>25 cm) that cross the knee. 3 Commonly used techniques include plain balloon angioplasty, drug-coated balloon (DCB) angioplasty, bare metal stents, drug-eluting stents and stent grafts for vessel perforation. Such endovascular approaches have been successfully used to alleviate symptoms in patients with claudication and have been associated with limb salvage in patients with CLI. [4][5][6] In many cases, such 'basic' approaches may be compromised by severe calcification. Calcification may be the reason for a poor primary outcome due to early recoil or extensive flow-limiting dissections after high-pressure angioplasty, culminating in the need for bailout stent placement. 7 Despite the most recent self-expandable nitinol stent technology, rates of re-stenosis may be high, resulting in primary patency rates of <50% for bare metal stents and <70% for drug-eluting stents at 5-year follow-up. 8 Even with dedicated stent devices, stent fractures may occur at sites of extensive movement and flexion as in the popliteal artery, resulting in stent thrombosis and subsequent occlusion. 9 With conventional open surgery, 5-year patency rates of more than 80% have been reported with saphenous vein grafts compared with 67% when using prosthetic conduits. 10 Although no randomised trials are currently available for a head-to-head comparison of endovascular versus surgical treatment for long and calcified femoropopliteal lesions, AbstractAn ageing population and the increasing prevalence of cardiovascular risk factors have aggravated the burden of peripheral artery disease (PAD). Despite advances in the pharmacological treatment of atherosclerosis, many patients with symptomatic PAD require invasive procedures to reduce the symptoms of claudication, salvage tissue and prevent a...

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Section: Directional Atherectomymentioning

confidence: 70%

The Role of Atherectomy in Peripheral Artery Disease: Current Evidence and Future Perspectives

Korosoglou¹,

Giuşcă²,

Andrassy³

et al. 2019

Vascular and Endovascular Review

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“…This is also supported by the work of Mehta et al on isolated CFA disease who compared DA/PTA against PTA alone, finding a 20‐month primary patency rate of 86% for DA/PTA, compared to 70.7% for DA alone at 20‐months, though it was not prospective nor powered for statistical significance. When DA is used in conjunction with DCB, 1‐year primary patency rates improved, ranging from 88% to 90% . These results demonstrate that the combination of DA debulking before PTA/DCB in treating isolated CFA disease can allow for a short‐term primary patency approaching that of CFE.…”

Section: Endovascular Therapies To Cfa Disease and Evidence For Theirmentioning

confidence: 75%

“…When DA is used in conjunction with DCB, 1-year primary patency rates improved, ranging from 88% to 90%. 34,41 These results demonstrate that the combination of DA debulking before PTA/DCB in treating isolated CFA disease can allow for a short-term primary patency approaching that of CFE. Several factors may account for this, including improved lumen size and effective debulking of eccentric lesions prior to adjunctive PTA or DCB to enhance drug uptake at the time of delivery.…”

Section: Atherectomy and Adjunctive Therapiesmentioning

confidence: 76%

Management of common femoral artery occlusive disease: A review of endovascular treatment strategies and outcomes

Wong

Lahsaei

Aoun

et al. 2018

Cathet Cardio Intervent

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Isolated atherosclerotic lesions of the common femoral artery (CFA) are rare but can produce significant claudication and critical limb ischemia. To date, the “gold standard” treatment for this entity has been common femoral endarterectomy (CFE) with or without patch angioplasty. However, surgery does have significant early postoperative complications, with a 15% combined mortality/morbidity. This manuscript sought to perform a comprehensive review of all studies and available data on endovascular treatment of isolated CFA disease and compare its utility to the traditional gold standard treatment. Twenty‐one studies from 1987 to 2018 were included exploring the various CFA endovascular therapies (percutaneous transluminal angioplasty, intravascular stenting, drug‐coated balloons, and directional atherectomy employed to treat CFA disease, in terms of efficacy, safety, and complications). As a conclusion, endovascular interventions provide acceptable short‐term technical outcomes for CFA disease while limiting procedural complications. While only two randomized controlled trials compare short and long‐term outcomes of surgical versus endovascular treatment, further studies are required to clarify the role of endovascular therapy.

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“…Surgical endarterectomy has historically been the treatment of choice for CFA disease . However, recent reports of EVT (DCB, atherectomy, stenting) and a randomized trial of stenting versus surgery have demonstrated high technical success, improved safety and comparable patency for EVT compared to open surgery for CFA lesions. Data derived from a large pooled analysis ( n = 1,014) from the Vascular Quality Initiative, demonstrate low procedural morbidity with CFA EVT (77% cases were PTA) .…”

Section: Methodsmentioning

confidence: 99%

SCAI consensus guidelines for device selection in femoral‐popliteal arterial interventions

Feldman

Armstrong

Aronow

et al. 2018

Cathet Cardio Intervent

131

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Combined use of directional atherectomy and drug-coated balloon for the endovascular treatment of common femoral artery disease: immediate and one-year outcomes

Abstract: This single-centre prospective study suggests that the combined use of DA and DCB is a safe and effective alternative to surgery, a treatment option for common femoral artery lesions and provides encouraging results in this setting.

Cited by 49 publications

References 18 publications

The Role of Atherectomy in Peripheral Artery Disease: Current Evidence and Future Perspectives

The Role of Atherectomy in Peripheral Artery Disease: Current Evidence and Future Perspectives

Management of common femoral artery occlusive disease: A review of endovascular treatment strategies and outcomes

SCAI consensus guidelines for device selection in femoral‐popliteal arterial interventions

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