Common Femoral PCI Becomes a Valid Alternative

Gentileza del Dr. Carlos Fava.

The common femoral artery has always been treated with surgery. Thanks to the development of new generation stents and the advancement of percutaneous intervention, common femoral lesions are currently being treated with PCI. However, data on the safety of PCI vs. surgery, remain unavailable. 

The TECCO is multicenter study, randomized 1:1 to stent vs. surgery, on common femoral artery lesions (CFA).

It included patients presenting severe lesions in the CFA and symptomatic intermittent claudication (Rutherford stage 3-6). It excluded thrombosis, restenosis and nonatheromatous severe lesions (dysplasia, and traumatic, or inflammatory lesions). Superficial femoral lesions were classified as:

1. Type I: external iliac extending to CFA;
2. Type II: limited to CFA;
3. Type III: CFA extending to bifurcation;
4. Type IV: restenosis (these last cases were excluded).

Primary end point was mortality and morbidity rate at 30 days (which included local and general complications), prolonged hospitalization and reintervention. Clinical end point was Rutherford improvement, trophic lesion resolution or resting pain resolution.

Also read: “PCI with Drug Coated Balloon in the Superficial Femoral Artery”.

It included 56 patients receiving stents and 61 receiving surgery. The characteristics of both populations were well balanced.

Procedural success was 100% for all surgery patients and 94.6% for those who chose PCI (3 required conversion to surgery).

At 30 days, primary end point was higher for surgery (26% vs. 12.5% p=0.05), driven by higher morbidity (local complications related to surgery) and hospitalization days (3.2±2.9 vs. 6.3±3 days p<0.0001), with no difference in mortality.

Also read: “A New Alternative to Common Femoral Artery PCI”.

At two year follow up, there were no differences in final clinical point, with similar survival, primary patency, and target lesion revascularization rates and functional class improvement.

Conclusion

In patients with the novo lesions in the common femoral artery, periprocedural mortality and morbidity rate was significantly lower in those undergoing stenting while clinical, morphological and hemodynamic evolution, was comparable at mid-term.

Comment

The common femoral artery is one of the last limitations to PCI. This is due to its high mobility, which has been associated to stent fracture. However, in theory, this could be overcome with the new peripheral stents. 

What matters is that this randomized study presented benefits at 30 days, with lower morbidity and hospitalization days, which certainly translates into significant cost reduction with similar evolution at 2 years. 

We should continue this line of research with larger studies (randomized, if possible) to know whether we will eventually be able to treat CFA stenosis percutaneously.

Gentileza del Dr. Carlos Fava.  

Título original: Stenting or Surgery for de Novo Common Femoral Artery Stenosis.

Referencia: Yann Gouefffi, et al J Am Coll Cardiol Intv 2017;10:1344-54.

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