Intravascular Lithotripsy for Common Femoral Artery Occlusive Disease

The aim of this study is to assess the safety and feasibility of intravascular lithotripsy (IVL) for the treatment of the common femoral artery (CFA).

We analyzed patients who received IVL treatment for CFA from September 2021 to April 2023. All patients included presented with chronic limb-threatening ischemia. Standard procedure was IVL with adjunctive drug-coated balloon (DCB) angioplasty using either Paclitaxel or Sirolimus. Primary endpoint was to assess effectiveness of IVL for atherosclerotic common femoral lesions. Secondary endpoints include major adverse events and clinically driven target lesion revascularization.

A total of 15 patients were included in the study. All but 1 received IVL + DCB angioplasty. Technical success was 100% with a mean residual stenosis after IVL of 11.88% (standard deviation [SD] 6.8). No scaffolding was needed. Adjunctive DCB angioplasty was used in 14 patients, 4 of them with a Paclitaxel-coated balloon and Sirolimus-coated balloon in the other 10 patients. One major adverse event was registered due to worsening of renal function in a patient with previous chronic kidney disease. Three patients died during the postoperative period, and for the other 11 patients, the mean follow-up was 14 months (SD 5.68). Mean upgrade in Rutherford Class was 3.58 (SD 0.79) and cumulative clinically driven target lesion revascularization during follow-up was 0%.

IVL with adjunctive DCB angioplasty is a safe and feasible technique for treating CFA in chronic limb-threatening ischemia patients, with lower morbidity and mortality rates compared with open surgical series described in the literature. This implies shorter hospital stay and a faster recovery. IVL may be a good alternative to open surgery, but these encouraging early results must be confirmed with long-term follow-up studies.