Directional Atherectomy of the Common Femoral Artery. Learning Curve and One Year Follow up

Abstract

Introduction: The use of Directional Atherectomy (DA) with or without anti-restenotic therapy (ART) may be considered for the management of common femoral artery (CFA) occlusive disease because of its minimally invasive nature with early mobilisation, reduced incision complications and infection rates [1-5]. However, it has recognised complications, which may be related to the learning curve. We present our initial experience using DA and suggest changes that may, based on our practice, improve outcomes. Methods: A consecutive series of patients who underwent CFA DA +/- ART for chronic limb ischemia with > 70 % CFA stenosis in two tertiary hospitals between June 2017 and December 2018 are described here. All of them had Ultrasound (USS) and /or Computerised Tomography Angiogram (CTA) before the procedure. Data were collected prospectively and retrospectively evaluated. The primary endpoints were technical success (< 50% residual stenosis in the CFA measured by USS after the procedure), primary patency of the CFA measured by USS at 1, 3, 6 and 12 months and also morbidity and mortality. Secondary endpoints were change in Rutherford-Becker class, target lesion revascularisation rate and length of stay post-procedure. Patients were selected for DA by the treating surgeon based on IFU and significant comorbidities. CFA DA was performed in isolation or in conjunction with other endovascular treatment of the iliac/ipsilateral femoral or tibial vessels Results: Between July 2017 and December 2018, 25 patients underwent CFA DA. Two had an occluded CFA and 23 had >70% CFA stenosis as determined by USS [6, 7] and CTA preop. There were no deaths within 30 days. Procedure-related complications included 2 cases of CFA pseudoaneurysm (one of them repaired by open surgery) (Figure 1 and Figure 2) and 1 CFA perforation (repaired with covered stent). No distal embolisation or limb loss occurred. The mean length of stay was: 1.96 days. The primary and secondary patency at 3 and 6 months was 100%. At 12 months it was 96%. Conclusion: Early results suggest that CFA DA ± ART is safe & effective and may be advantageous over open endarterectomy in some patients. However preoperative imaging or intravascular USS (IVUS) may be required to ensure that the device passes are in areas of highest plaque burden to avoid early complications and localised dilatation over time.Figure 2A: Pre DA. B: Post CFA DA + EIA Viabahn. C: Duplex USS 6 month later. D: 6 months later.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Disclosure: Nothing to disclose