Directional Atherectomy of the Common Femoral Artery: Complications and Outcomes

Ann Vasc Surg . 2020 Jul;66:621-630. doi: 10.1016/j.avsg.2020.01.094. Epub 2020 Feb 5.

Fecha de la publicación: 05/02/2020

Autor: Fernando Picazo (1), Ricky C H Kwok (2), Joseph A Hockley (2), Marek W Garbowski (2), Shaun D Samuelson (3), Shirley J Jansen (4)

PMID

PMID: 32035268
DOI: 10.1016/j.avsg.2020.01.094

Affiliations

¹Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. Electronic address: fpicazopineda@gmail.com.

²Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.

³Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.

⁴Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Curtin University Medical School, Curtin University, Perth, Western Australia, Australia; Faculty of Health and Medical Sciences, University of Western Australia, Western Australia, Australia; Heart and Vascular Research Institute, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia.

Abstract

Background: The use of directional atherectomy (DA) with or without drug-coated balloon (DCB) may be considered for the management of common femoral artery (CFA) occlusive disease because of its minimally invasive nature with early mobilization, reduced incision complications, and infection rates. However, it has recognized 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: Retrospective analysis with a prospective data collection from 2 centers to analyze outcomes in all consecutive patients treated during 1 year (n = 25). Patients who underwent CFA DA with/without DCB for CFA >70% stenosis. Primary end points include technical success, primary patency of the CFA, morbidity, and mortality. Secondary end points include change in Rutherford-Becker class, length of stay, and target lesion revascularization rate.

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 ultrasound scan (USS) and/or computed tomography angiogram (CTA) preoperatively. There were no deaths within 30 days. Procedure-related complications included 2 cases of CFA pseudoaneurysm (one of them repaired by open surgery) and 1 CFA perforation (repaired with covered stent). No distal embolization or limb loss occurred. Mean length of stay was 1.9 days. Primary and secondary patency at 3 and 6 months was 100%. At 12 months, it was 96%.

Conclusions: Early results suggest that CFA DA with/without DCB is safe and effective. Previous CTA, focused USS, and/or intravascular USS may be useful to minimize the risk of pseudoaneurysm or perforation by excessive thinning of the media. Experience is required to prevent localized dilatation over time.