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. 2024 Sep 27;12(10):2213.
doi: 10.3390/biomedicines12102213.

Three-Year Safety and Efficacy of Endovascular Treatment of Common Femoral Artery in 150 PAD Patients

Patricia Wischmann  1   2 , Manuel Stern  1 , David-Ioan Florea  1 , Luise Neudorf  1 , Yassine Haddad  1 , Nicolas Kramser  1 , Miriam Schillings  1 , Sven Baasen  1 , Johanna Schremmer  1 , Christian Heiss  3   4 , Malte Kelm  1   2 , Lucas Busch  1
Affiliations

Three-Year Safety and Efficacy of Endovascular Treatment of Common Femoral Artery in 150 PAD Patients

Patricia Wischmann et al. Biomedicines. .

Abstract

Background: The gold standard treatment for peripheral arterial disease (PAD) of the common femoral artery (CFA) is open common femoral endarterectomy (CFAE). Interest in the less invasive endovascular treatment (EVT) is growing due to PAD patients' frequent co-morbidities. Aims: We aimed to evaluate three-year EVT outcomes in multimorbid PAD patients with severe calcified CFA lesions. Methods: Using the prospectively maintained "all-comers" Duesseldorf PTA Registry, we analysed the three-year outcomes of 150 patients with EVT of the CFA. Between January 2017 and October 2023, 66 patients received a rotational excisional atherectomy (REA) followed by a drug-coated balloon angioplasty (DCB), and 84 patients received a DCB alone. Results: All procedures involved the CFA, 49% additionally involved the proximal superficial femoral artery (SFA), and 10% of the lesions involved the profunda femoris artery (PFA). The procedural success rate was 97% and independent of PAD stage, with a higher level of stent implantation in the DCB group (58% vs. 39%, p < 0.05). The primary patency rate at one year was 83% for REA + DCB and 87% for DCB (p = 0.576), while secondary patency after three years was 97%. The MALE rate at three years was mainly driven by cdTLR (REA + DCB: (20%) vs. DCB: (14%), p = 0.377), while major amputations were low in both groups (REA + DCB: 3% vs. DCB: 1%). Overall, the major adverse cardiovascular events (MACEs) rate at three years was low (REA + DCB: (5%) vs. DCB: (11%), p = 0.170). Conclusions: The EVT of severely calcified CFA lesions is safe and effective, with high three-year patency rates and low rates of major adverse limb events (MALEs) and MACEs. This registry demonstrates that vessel preparation with REA minimizes the need for stenting.

Keywords: common femoral artery; directional atherectomy; endovascular therapy.

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Conflict of interest statement

The authors have reported that they have no other relationships relevant to the contents of this paper to disclose.

Figures

Figure 1
Figure 1
Kaplan–Meier survival analysis at three years for REA + DCB group and DCB group (A) cdTLR-free survival rate, (B) freedom from major adverse limb event (MALE: major amputation and clinical-driven target lesion revascularisation [cdTLR]), (C) amputation-free survival, and (D) overall survival rate. Overall p-values are shown, see Table 5 for 95% confidence intervals of individual groups.
See this image and copyright information in PMC

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