Introduction: Gold standard treatment for occlusive lesions of the common femoral artery used to
be endarterectomy. In recent years, interest for endovascular treatment of the common
femoral artery has been increasing. Stenting of the common femoral artery is possible,
however we believe it is better to avoid it. Calcified arterial lesions cannot be
treated well with drug-coated balloons alone. Vessel preparation with rotational atherectomy,
followed by drug-eluting balloon usage, could be a good option.
Methods: Between June 2021 and March 2022, 22 patients with 26 occlusive diseases of the common
femoral artery had been treated with rotational atherectomy followed by drug-coated
balloon. They were reviewed prospectively.
Results: There were 15 men and 7 women, each group including 2 with bilateral lesions. Mean
age was 75 years old. 86% of the patients had had arterial hypertension, 55% used
to smoke, 32% had had diabetes and 86% had had dyslipidemia. 7 patients had had chronic
kidney disease. 18 legs had had preoperative Rutherford stage 3 peripheral arterial
disease, 3 stage 2, 3 stage 4 and 2 stage 5. The mean preoperative ankle brachial
index was 0,69. The mean length of the lesions was 4,2 cm. All lesions were heavy
calcified. 3 chronic total occlusions were present. All procedures were performed
with the patient under local anesthesia. 19 were anterograde with contralateral femoral
puncture and 7 were retrograde with ipsilateral superficial femoral puncture. No filters
were used. Technical success rate was 100%. One case of asymptomatic embolization
had occurred in the deep femoral side branch. One of the patient had died after one
month following cardiac decompensation. Two patients had experienced a none-ST-elevation
myocardial infarction, one on the first and one on the 30th postoperative day. 2 patients
had developed a false aneurysm at the puncture site, one treated surgically and with
thrombin injection. All others had had no complications. Mean follow up was 4 months.
Primary patency rate was 100%. All patients had had decreased Rutherford stage peripheral
arterial disease. Enrollment and follow-up are on-going.
Conclusion: These short term results have shown that rotational atherectomy with drug-coated
balloon angioplasty for common femoral calcified occlusive disease is feasible and
safe. It has the advantages of avoiding the potential complications of surgical treatment,
and of leaving nothing behind (no stent). Long term results will be required.
