Treating Common Femoral Artery Steno-occlusive Lesions With an Endovascular Approach Using DA + DCB: 3-year Follow-up in 75 Patients

During a session that focused on novel approaches and insights for treatment of complex femoropopliteal disease, Dr. Angelo Cioppa, from Montevergine Clinic in Mercogliano, Italy, shared the results of a study that looked at combining the advantages of open surgery with endovascular surgery. From 2014 to 2018, 131 patients underwent percutaneous transluminal angioplasty of the common femoral artery in the Clinic due to critical limb ischemia (28 [21.2%]) or lifestyle-limiting claudication (108 [78.8%]). Directional atherectomy with antirestenotic therapy (DAART) was performed in 96 patients, and a 3-year follow-up was completed in 75 patients. In 2017, the first results on 30 patients showed encouraging results, with target lesion revascularization less than 10% and bailout stenting around 10%.

Procedural success was 100%, crossing the lesion and treating the lesion with DAART, and no distal embolization occurred. A significant amount of debris was found in the distal protection system, and there were no procedure or access site complications. Acute angiographic success was 100% (residual stenosis <30%). Bailout stenting was used in 6 cases (8%), and no death or major amputation was seen in the first 30 days. Primary patency was 89.8% at 1 year, 87.2% at 2 years, and 84.7% at 3 years. Secondary patency was 93.2% after 3 years.

In conclusion, the data suggest that endovascular therapy of the common femoral artery is safe and effective in the long run. A direct atherectomy (DA) + drug-coated balloon (DCB) strategy may have some advantages compared with other endovascular techniques: it’s similar to surgery but less invasive; it improves DCB efficacy in calcified lesions; and it applies the “leave nothing behind” theory, thereby reducing bailout stenting. “It’s time to start a randomized trial to compare DAART to surgery and other endovascular therapies,” Dr. Cioppa concluded.