Directional Atherectomy of the Common Femoral Artery: Complications and outcomes

Abstract Objectives 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 mobilisation, reduced incision complications and infection rates. However, it has recognised 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 two centres to analyse outcomes in all consecutive patients treated over one year (n=25). Patients who underwent CFA DA +/- DCB for CFA>70% stenosis. Primary endpoints: technical success, primary patency of the CFA, morbidity, mortality. Secondary endpoints: change in Rutherford-Becker class (R), length of stay and target lesion revascularisation rate (TLR). Results Between July 2017 and December 2018, 25 patients underwent CFA DA. Two had an occluded CFA, 23 had >70% CFA stenosis as determined by USS and/or CTA preop. 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 embolisation or limb loss occurred. Mean length of stay: 1.9 days. Primary and secondary patency at 3 and 6 months was 100%. At 12 months it was 96%. Conclusion Early results suggest that CFA DA ± DCB is safe & effective. Previous CTA, focussed USS and /or intravascular USS (IVUS) may be useful to minimize the risk of pseudoaneurysm or perforation by excessive thinning of the media. Experience is required to prevent localised dilatation over time.