Outcomes of directional atherectomy for common femoral artery disease

Böhme, Tanja; Romano, Leonardo; Macharzina, Roland-Richard; Noory, Elias; Beschorner, Ulrich; Jacques, Börries; Bürgelin, Karlheinz; Flügel, Peter-Christian; Zeller, Thomas; Rastan, Aljoscha

doi:10.4244/eij-d-19-00693

Cited by 15 publications

(9 citation statements)

References 35 publications

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“…Here we demonstrated a less invasive and successful EVT procedure for severe nodular calcification in CFA. Atherectomy devices are adjunctively important for debulking heavily calcified plaques (Panaich et al 2016 ), and a greater plaque volume reduction usually results in more efficient balloon angioplasty and/or stenting (Böhme et al 2021 ; Hassan et al 2021 ). Various types of debulking devices are now available in most countries, but unfortunately, none designed for EVT are covered by insurance in our country.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous debulking strategy for severe nodular calcification in common femoral artery

et al. 2022

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Background Despite marked progress in endovascular treatment (EVT) techniques and devices, calcified lesions remain one of the toughest obstacles to EVT success. Moreover, because the common femoral artery (CFA) is known as a “non-stenting zone,” endovascular strategies for this area are controversial. Case presentation Here we describe the technical tips for a novel, less invasive, and effective debulking strategy for severe nodular calcification using an endovascular maneuver. This technique was demonstrated in a 73-year-old man with severe calcified stenosis of the CFA. To complete a stent-less strategy for CFA, we conducted aggressive debulking of the nodular calcification, established a bidirectional approach from the radial artery and the superficial femoral artery (SFA), and inserted a balloon-guiding catheter in the SFA. Under distal protection provided by this catheter, we crushed the nodular calcification 43 times using myocardial biopsy forceps. After achieving a volume reduction of nodular calcification through this maneuver, we completed the procedure by inflating a 6-mm drug-coated balloon catheter. Final angiography demonstrated a reduced filling defect of the contrast medium in the CFA and favorable blood flow as far as the ankle. The puncture site on the SFA was closed with a vascular suture assisted by balloon inflation inside the vessel, which allowed the patient to be ambulatory immediately after the procedure without requiring bed rest. Conclusions Severely calcified lesions in the CFA are usually difficult to treat using an endovascular strategy, but our novel and less invasive method may become a promising technique for managing these lesions.

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Section: Discussionmentioning

confidence: 99%

Percutaneous debulking strategy for severe nodular calcification in common femoral artery

et al. 2022

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“…25,26 The rates of major procedural complications including pseudoaneurysm formation, vessel perforation, and distal embolization are variably reported but overall major procedural morbidity rate ranges between 10 and 12%. 25,26 The durability of such interventions has been questioned with mid-term results out to 3 years showing primary and secondary patency approaching 85 to 90%. 27 Most study designs limit analysis of isolated atherectomy outcomes as combination therapy with adjunct DCB treatment and/or stenting for residual stenosis is used in the majority of cases.…”

Section: Atherectomymentioning

confidence: 99%

“…27 Most study designs limit analysis of isolated atherectomy outcomes as combination therapy with adjunct DCB treatment and/or stenting for residual stenosis is used in the majority of cases. [25][26][27][28] Studies evaluating the safety and efficacy of traditional orbital atherectomy in the common femoral demonstrate comparable short-term outcomes with no significant difference in major morbidity compared to directional techniques. Again, the majority of cases undergoing orbital atherectomy require adjuvant DCB and/or stenting.…”

Section: Atherectomymentioning

confidence: 99%

“…Directional atherectomy is best suited to address the eccentric plaque commonly seen in the common femoral system with previous work demonstrating good technical success. 25 26 The rates of major procedural complications including pseudoaneurysm formation, vessel perforation, and distal embolization are variably reported but overall major procedural morbidity rate ranges between 10 and 12%. 25 26 The durability of such interventions has been questioned with mid-term results out to 3 years showing primary and secondary patency approaching 85 to 90%.…”

Section: Endovascular Managementmentioning

confidence: 99%

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Surgical, Endovascular, and Multimodal Approaches to the Management of Atherosclerotic Common Femoral Artery Disease

Kugler

2023

Semin intervent Radiol

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Common femoral artery disease is at the heart of nearly all treatment algorithms and decisions for patients with symptomatic peripheral arterial disease. Surgical endarterectomy has been the mainstay of common femoral treatment with a wealth of data supporting its safety, efficacy, and durability. Advances in endovascular technology and techniques for the management of iliac and superficial femoral artery disease has resulted in a paradigm shift in management. The common femoral artery has been aptly named a “no stent zone” due to anatomic and disease-specific challenges that have limited the role for endovascular techniques. New technology and techniques in the endovascular management of common femoral disease seek to change our treatment strategies. A multimodal approach utilizing a combination of angioplasty, atherectomy, and stenting has been shown most beneficial, although limited long-term data leave durability an unanswered question. While surgical treatment remains the gold standard, advances in the endovascular approach will certainly continue to improve outcomes. As truly isolated common femoral disease is a rarity, a collaborative approach combining all benefits of open and endovascular techniques in the treatment of peripheral arterial disease is essential.

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“…The primary 1-year patency rates after surgical endarterectomy reported in the literature are 85–95% [ 4 ]. Numerous small studies indicate that endovascular therapy may have the potential to replace open surgery at least for some anatomical characteristics of CFA lesions [ 5 , 6 , 7 , 8 , 9 ]. In a retrospective study, the use of stents was associated with significant lower 1-year restenosis and target lesion revascularization (TLR) rate and was a protective factor against procedure failure [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Stent Angioplasty in the Treatment of Arteriosclerotic Lesions of the Common Femoral Artery

Böhme

Zeller

Abboud

et al. 2022

JCM

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In many vascular segments, endovascular therapy is the treatment of choice for arteriosclerotic lesions. For the treatment of common femoral artery (CFA) lesions, surgical reconstruction is still considered the gold standard. The purpose of this study is to evaluate the safety and efficacy of stent angioplasty for the treatment of common femoral artery (CFA) lesions in a real-world population during a two-year follow up. This retrospective, single-center study includes 250 patients requiring treatment with stent angioplasty of CFA lesions. The primary end point was the target lesion revascularization (TLR) rate. Secondary end points were the overall procedural complication rate, the rate of ipsilateral CFA punctures during follow-up, changes in the Rutherford–Becker class (RBC) and ankle–brachial index (ABI), primary patency rates, amputation rate, time to and the type of TLR. A total of 236 interventions (94.4%) were successfully defined as a residual stenosis < 30%. Periinterventionally, there were 23 complications (9.1%), 3 of which had to be treated surgically. Median follow up was 21 months (average 19.2 ± 7.8). In total, 41 patients (16.4%) needed a TLR. The primary patency rate was 90.8%, 81.2% and 72% at 6, 12 and 24 months, respectively. ABI and RBC were significantly better at all time points compared to baseline. During follow up, seven amputations (three minor and four major) had to be performed. More than half of the patients (56.0%) were punctured at the stented CFA during the follow up. Multivariate logistic regression analysis showed continued nicotine use and coronary heart disease as predictors for TLR. Stent angioplasty for the treatment of CFA lesions is safe and effective. Further studies are needed to compare this endovascular option with surgical therapy.

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Outcomes of directional atherectomy for common femoral artery disease

Cited by 15 publications

References 35 publications

Percutaneous debulking strategy for severe nodular calcification in common femoral artery

Percutaneous debulking strategy for severe nodular calcification in common femoral artery

Surgical, Endovascular, and Multimodal Approaches to the Management of Atherosclerotic Common Femoral Artery Disease

Evaluation of Stent Angioplasty in the Treatment of Arteriosclerotic Lesions of the Common Femoral Artery

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