The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Midterm Results of Directional Atherectomy for the Treatment of Atherosclerotic Common Femoral Artery Disease

DOI: 10.4244/EIJ-D-19-00693

1. Kardiologie und Angiologie II, Universitats-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany, Germany
2. Klinik für Angiologie, Klinikum Hochsauerland, Arnsberg, Germany
3. Medizinische Uniklinik, Angiologie, Kantonsspital Aarau, Switzerland

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Aims: To evaluate the safety and efficacy of directional atherectomy (DA) for the treatment of common femoral artery (CFA) lesions.

Methods and results: A retrospective analysis of patients who underwent DA of the CFA between March 2009 and June 2017 was performed. The primary efficacy endpoint was the incidence of clinically-driven target lesion revascularization (cdTLR). Secondary endpoints included the overall procedural complication rate at 30 days, change in ankle-brachial index (ABI), and Rutherford-Becker class (RBC) during follow-up.This analysis included 250 patients. The mean follow-up period was 31.03±21.56 months (range 1-88, median follow-up period 25 months). Procedural complication rate including access site complications, target lesion perforation, and outflow embolization was 10.4% (n=26). All but one complication could be treated conservatively or endovascularly. One surgical revision was necessary. Freedom from major adverse events (death, cdTLR, myocardial infarction and major target limb amputation) at 30 days was 99.6%. CdTLR rate during follow-up was 13.6% (n=34). A significant improvement of the mean ABI and the RBC could be observed, respectively. Multivariate logistic regression analysis revealed residual target lesion stenosis >30% (p=0.005), and heavy calcification of the target lesion (p=0.033) as independent predictors for cdTLR.

Conclusions:The use of DA for the treatment of CFA lesions leads to promising mid-term results with an acceptable complication rate.

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