Courtesy of Dr. Carlos Fava.

Not long ago, atherosclerosis of the common femoral artery used to be treated surgically and, thanks to better training and new balloon devices, we have advanced the endovascular treatment alternative. However, severe calcification continues to be a great limitation.

This study aimed at evaluating the feasibility and one year efficacy of the endovascular treatment of the common femoral artery with the combined use of directional atherectomy and the paclitaxel coated balloon.

The study included 30 patients presenting intermittent claudication, severe or with critical ischemia, undergoing peripheral PCI with the drug coated balloon and directional atherectomy.

Mean age was 78; most patients were men and diabetic. Five patients presented severe kidney failure (GFR <30 ml/min), and three of these required dialysis.

All patients saw technical and procedural success and only 3 required stent implantation.

At one year follow up, all limbs were salvaged with no major amputations. Two patients presented restenosis and only one presented the need for revascularization. Secondary patency was 96.7% and freedom from major events in the treated limb was 93.4%.

Conclusion

This prospective study suggests that the combination of directional atherectomy and a paclitaxel coated balloon is safe and effective as an alternative to surgery. In addition, it is a valid option to treat the common femoral artery and provides encouraging results in this context.

Editorial Comment

Common femoral artery lesions are one of the most challenging given their anatomical location and limited stenting options.

The combination of these two techniques could provide an endovascular solution to treat these obstruction, but this territory requires further stent developing, more flexibility and lower fracture rate.

Courtesy of Dr. Carlos Fava. Favaloro Foundation, Buenos Aires, Argentina.

Original Title: Combined use of directional atherectomy and drug-coated balloon for the endovascular treatment of common femoral artery disease: immediate and one year outcomes.

Reference: Angel Cioppa et al. EuroIntervention 2017;12:1789-1794.

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