Mid-term Outcomes of Percutaneous Atherectomy of Common Femoral Arterial Lesions
Hyangkyoung Kim1, Sungsin Cho2, Jin Hyun Joh2
1Department of Surgery, Ewha Womans University Mokdong Hospital, Seoul, South Korea.
Insights
Percutaneous atherectomy for common femoral artery (CFA) lesions offers durable mid-term patency and limb salvage. This minimally invasive approach is a viable alternative for high-risk patients unsuitable for surgery.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Peripheral Artery Disease
Background:
- Common femoral artery (CFA) atherosclerotic lesions can lead to chronic limb-threatening ischemia.
- Surgical endarterectomy is a traditional treatment but carries significant risks for high-risk patients.
- Minimally invasive options are needed to improve outcomes and reduce morbidity.
Purpose of the Study:
- To evaluate the mid-term clinical and angiographic outcomes of primary percutaneous atherectomy for isolated CFA atherosclerotic lesions.
- To assess the safety and efficacy of atherectomy as a standalone treatment for CFA disease.
Main Methods:
- Retrospective analysis of 49 patients (50 limbs) undergoing directional or rotational atherectomy for isolated CFA lesions.
- Inclusion of elderly, high-risk patients, many with chronic limb-threatening ischemia and severe calcification.
- Primary endpoint: primary patency (freedom from ≥50% restenosis or target lesion revascularization) assessed by duplex ultrasound up to five years.
Main Results:
- High technical success rate (98.0%) with minimal need for bailout stenting (6.1%).
- Significant improvement in ankle-brachial index (0.66 to 0.95, P < 0.001).
- Excellent primary patency rates at 1 year (95.6%) and 3 years (79.6%), with high limb salvage (97.9%) and survival (90.3%) at 3 years.
Conclusions:
- Primary percutaneous atherectomy provides durable mid-term results for isolated CFA lesions.
- Outcomes are comparable to surgical endarterectomy, with reduced invasiveness and no need for permanent implants.
- This technique is a feasible alternative for selected high-risk or surgically unsuitable patients.
Objective:
To evaluate the mid-term clinical and angiographic outcomes of primary percutaneous atherectomy for isolated atherosclerotic lesions of the common femoral artery (CFA).
Methods:
This retrospective, single-center study included 49 patients (50 limbs) who underwent directional or rotational atherectomy between January 2017 and December 2025. The cohort was elderly (mean age 71.9 ± 6.9 years) and high risk, with 55.1% presenting with chronic limb-threatening ischemia. Severe calcification (>50% circumference) was observed in 73.5% of lesions. The primary endpoint was primary patency, defined as freedom from ≥50% restenosis or target lesion revascularization (TLR), assessed by duplex ultrasound up to 5 years.
Results:
Technical success (<30% residual stenosis) was achieved in 98.0%. Bailout stenting was required in 6.1%. The ankle-brachial index improved from 0.66 ± 0.19 to 0.95 ± 0.19 (P < 0.001). Primary patency rates were 95.6% and 79.6% at 1 and 3 years, respectively. TLR occurred in 20.0% of lesions during follow-up. Three-year overall survival and limb salvage rates were 90.3% and 97.9%, respectively. The 30-day major complication rate was 0.0%, with a single minor access-site hematoma (2.0%) managed conservatively. The median hospital stay was 1 day (IQR, 1-2 days).
Conclusion:
Primary percutaneous atherectomy for isolated CFA lesions demonstrates durable mid-term patency, with outcomes approaching those reported for surgical endarterectomy, while minimizing invasiveness and avoiding permanent implants. These findings suggest that this approach may be considered a feasible alternative in selected high-risk or surgically unsuitable patients.
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