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Phoenix Atherectomy in Calcified Common Femoral and Popliteal Artery Chronic Total Occlusion. A Retrospective Cohort
Jacob R Devine1, Tanner Berg1, Joshua Schumacher1
1University of South Dakota Sanford School of Medicine.
Insights
Phoenix atherectomy offers a safe and effective treatment for complex arterial blockages in the legs. This study shows high success rates and good patient outcomes with minimal complications.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Interventions
Background:
- Chronic total occlusions (CTOs) in the common femoral artery (CFA) and popliteal artery (PA) present significant treatment challenges, particularly when calcified and high TASC (Trans-Atlantic Inter-Society Consensus) classifications.
- Atherectomy, a minimally invasive technique, is increasingly utilized for revascularization, but its safety and efficacy in complex CTOs require further evaluation.
Purpose of the Study:
- To evaluate the short-term safety, procedural success, and clinical efficacy of the Phoenix atherectomy device.
- To assess outcomes in patients with calcified, high TASC CFA and PA chronic total occlusions.
Main Methods:
- A single-center retrospective study included 51 patients undergoing Phoenix atherectomy for calcified CFA and PA CTOs between 2021 and 2023.
- Lesion characteristics included TASC classifications B, C, and D, with severe calcification in half of the cases. Intravascular ultrasound was used in 50% of patients, and drug-coated balloons were employed in all cases.
Main Results:
- 100% procedural success was achieved, defined as residual stenosis <30%, with no distal embolization events. Only one bail-out covered stenting was required for a distal popliteal artery perforation.
- No immediate post-procedural complications (within 24 hours) were reported. At 6 weeks, 60% experienced claudication resolution and 40% achieved wound healing without major amputation.
- Clinically driven target lesion revascularization occurred in 3 patients at 4, 5, and 6 months post-procedure.
Conclusions:
- Phoenix atherectomy demonstrates a safe and effective treatment option for complex, calcified CFA and PA CTOs.
- The procedure is associated with very low rates of bail-out stenting and complications, alongside promising clinical efficacy.
- This technique offers a viable solution for limb salvage and symptom improvement in challenging lower extremity arterial disease.
Introduction:
To study the short-term safety, procedural success and efficacy of Phoenix atherectomy in calcified, high TASC CFA and PA chronic total occlusions.
Methods:
In this single center retrospective study, we included all patients who underwent Phoenix atherectomy for their calcified CFA and PA CTOs from 2021 to 2023 at Monument Health Rapid City Hospital, Rapid City, South Dakota.
Results:
The final cohort consisted of 51 patients, 22 presenting with chronic limb threatening ischemia and 29 with claudication and 51 limbs. Twelve CFA, 25 PA, 4 combined CFA and PA, 5 combined PA and superficial femoral artery [SFA], 5 combined CFA, SFA and PA CTOs were included, half of the lesions were severely calcified, 11 were TASC B, 37 were TASC C and 2 were TASC D lesions. Intravascular ultrasound was performed in half of the patients and drug coated balloons was used in all the patients. Procedural success was achieved in 100% of the patients [residual stenosis of less than 30%], one bail-out covered stenting for a distal popliteal artery perforation, no distal embolization protection devices was used and there were no embolization events. There were no immediate post procedural complications [less than 24 hours]. One death occurred 20 days later from an acute coronary syndrome. At 6 weeks follow-up, 60% had complete resolution of claudication and 40% achieved wound healing with no major amputation. Average peak systolic velocity of the CFA and PA was 214 cm/s and 91 cm/s, respectively with PSVR of less than 2.4 at 6 weeks' follow-up. Clinically driven target lesion revascularization occurred in 3 patients at 4, 5 and 6 months after the index procedure.
Conclusions:
Phoenix atherectomy can be used safely and effectively in calcified, high TASC common femoral and popliteal artery chronic total occlusions with extremely low rates of bail-out stenting and other complications and reasonable clinical efficacy.
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