Novel Common Femoral Artery Lesion Classification in Patients Undergoing Endovascular Revascularization
Martín Rabellino1, Juan Valle Raleigh2, Juan Guido Chiabrando3
1Department of Angiography and Endovascular Therapy, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Insights
A new classification for common femoral artery (CFA) lesions was proposed, identifying a frequent and extensive group (IV) associated with longer procedures and increased need for bailout access. This aids in better diagnostic and therapeutic approaches for CFA disease.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Radiology
Background:
- The common femoral artery (CFA) is a critical arterial segment in the lower limb.
- Existing classifications may not adequately address extensive CFA lesions.
- Accurate classification is essential for guiding diagnostic and therapeutic strategies.
Purpose of the Study:
- To propose an extensive classification system for common femoral artery (CFA) lesions.
- To evaluate the impact of this new classification on diagnostic and therapeutic approaches.
- To identify specific lesion characteristics influencing endovascular treatment outcomes.
Main Methods:
- Retrospective analysis of 58 lower limbs with CFA lesions undergoing endovascular therapy.
- Evaluation of lesion extension, stenosis degree, and calcium burden.
- Introduction of a new group (IV) for lesions extending from iliac arteries into the CFA bifurcation.
Main Results:
- The new group IV comprised 36% of lesions and was associated with significantly longer procedural times (76.9 min vs. 47.67 min) and higher rates of retrograde bailout access (23.8% vs. 2.6%).
- Occlusive lesions and heavy calcification were linked to longer procedures and increased need for bailout access compared to stenotic lesions or mild/moderate calcification.
- No significant differences were observed in secondary clinical outcomes or target lesion revascularization among the groups.
Conclusions:
- The proposed classification system effectively incorporates extensive and frequent CFA lesions previously unaddressed.
- This new classification aids in stratifying risk and optimizing procedural planning for complex CFA disease.
- It highlights the challenges associated with extensive CFA lesions, particularly concerning procedural complexity and access strategies.
Purpose:
Common femoral artery (CFA) is a critical segment of the lower-limb arterial tree. We sought to propose an extensive classification in order to appraise a diagnostic and therapeutic approach.
Methods:
A retrospective cohort of CFA lesions with endovascular therapy was evaluated. We appraised the extension, the degree of stenosis and the calcium burden. A new group "IV" included lesions that started at the external iliac artery or common iliac artery extending into the CFA and affecting its bifurcation. The primary outcome was the need for a retrograde bailout access after failed anterograde access and the procedural time.
Results:
From 2012 to 2020, a total of 58 lower limbs in patients with CFA lesions were included. New proposed group IV compromised 36% of lesions. Additionally, procedural time was significantly longer in group IV lesions compared with the rest (76.9 ± 32.23 min vs 47.67 ± 17.93 min, p < 0.01), as was the requirement of retrograde bailout access (23.8 vs 2.6%, p = 0.03). Occlusive lesions were associated with longer procedural times and bailout retrograde access compared to stenotic lesions (74.7 ± 33.6 min vs 48.29 ± 16 min, p < 0.001 and 26.1 vs 0%, p = 0.006, respectively), as well as heavy calcification compared to mild or moderate calcification (73.18 ± 28.15 vs 51.86 ± 25.1, p = 0.06 and 29.4 vs 2.4%, p = 0.009, respectively). Secondary clinical outcomes and target lesion revascularization did not differ among groups.
Conclusions:
Our classification includes a new group of extensive and frequent lesions, which did not fit in previous classifications.
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