Crossover of a Complex CTO Lesion Using the Double-Crossing Flossing Technique

Purpose: Gold standard treatment for occlusive lesions of the common femoral artery (CFA) used to be endarterectomy. In recent years, interest for endovascular treatment of the CFA has been increasing. Vessel preparation with rotational atherectomy, followed by drug-eluting balloon usage, could be a good option.

Materials and Methods: Between June 2021 and March 2022, 22 patients with 26 occlusive diseases of the CFA had been treated with rotational atherectomy followed by drug-coated balloon. They were reviewed prospectively.

Results: There were 15 men and 7 women. Mean age was 75 years. Eighteen legs had preoperative Rutherford stage 3 peripheral arterial disease (PAD). The mean preoperative ankle brachial index was 0.69. The mean length of the lesions was 4.2 cm. All lesions were heavily calcified. Three chronic total occlusions were present. All procedures were performed with the patient under local anesthesia. Nineteen were anterograde with contralateral femoral puncture and 7 were retrograde with ipsilateral superficial femoral puncture. No filters were used. Technical success rate was 100%. One case of asymptomatic embolization occurred in the deep femoral side branch. One of the patients died after 1 month following cardiac decompensation. Two patients experienced a non-ST-elevation myocardial infarction, 1 on the first and 1 on the 30th postoperative day. Two patients had developed a false aneurysm at the puncture site, and 1 was treated surgically and with thrombin injection. All others had no complications. At short term, the primary patency rate was 100 %. All patients had decreased Rutherford stage PAD.

Conclusions: These short-term results have shown that rotational atherectomy with drug-coated balloon angioplasty for common femoral calcified occlusive disease is feasible and safe. It has the advantages of avoiding the potential complications of surgical treatment, and of not leaving a stent.