Common Femoral Atherectomy yields safe results and low morbidity in the outpatient setting

Common femoral artery (CFA) endarterectomy is considered the gold standard for the treatment of CFA disease. Some patients with CFA occlusive disease have significant comorbidities that may prevent them from undergoing open surgery. Several endovascular treatment options for the CFA, such as atherectomy, angioplasty, and stenting, are available but have not been widely adopted. This study aimed to describe our experience expanding the use of atherectomy in the outpatient setting for the treatment of CFA disease.

This is a single-institution, retrospective review of 49 CFA atherectomy procedures performed from January 2017 to November 2022 at Trinity Health Ann Arbor. Primary outcomes included primary patency at 1 year and MALE-free survival. Secondary outcomes involved changes in ankle-brachial index (ABI), toe pressures, and morbidity at 90 days.

49 CFA atherectomies were performed on 45 patients (73 yo ± 7 years), 45% with claudication and 55% with critical limb-threatening ischemia (CLTI). TASC classification of the treated lesions was TASC A in 4%, TASC B in 29%, TASC C in 61%, and TASC D in 6%. Three patients also underwent superficial femoral artery (SFA) stenting; one had concomitant CFA stenting, and 24 (49%) underwent treatment distal to the CFA atherectomy site. We encountered three complications: one readmission for dehydration, one postoperative hematoma, and one focal SFA dissection requiring delayed secondary stent placement. There were no deaths within 90 days. Post-procedure, the average ABI increased from 0.59 to 0.80 (P<0.01), and toe pressure rose from 42 to 68 (P<0.01). Thirty-five cases had follow-up of at least one year, showing a primary patency rate of 86% and a 94% MALE-free at one year. Additionally, 71% reported symptom improvement or wound healing at their last follow-up.

When open surgery may be medically prohibited, CFA atherectomy combined with balloon angioplasty can be performed safely, yielding good clinical outcomes as a standalone procedure or with additional infrainguinal interventions. When applied in appropriate clinical and radiologic circumstances, patients experience favorable outcomes with low procedural morbidity. Due to its clinical benefits and low risk, this procedure can be a valuable addition to the modern vascular surgeon's treatment armamentarium.