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Evaluating Three-Year Outcomes of Endovascular Treatment for Common Femoral Artery Disease in 150 PAD Patients

https://doi.org/10.1007/s00392-025-02625-4

Patricia Wischmann (Düsseldorf)1, M. Stern (Düsseldorf)1, D.-I. Florea (Düsseldorf)1, L. Neudorf (Düsseldorf)1, N. Kramser (Düsseldorf)1, M. Schillings (Düsseldorf)1, S. Baasen (Düsseldorf)1, C. Heiss (Surrey)2, M. Kelm (Düsseldorf)1, J. Schremmer (Düsseldorf)1

1Universitätsklinikum Düsseldorf Klinik für Kardiologie, Pneumologie und Angiologie Düsseldorf, Deutschland; 2University of Surrey Faculty of Health and Medical Sciences Surrey, Großbritannien

 

Abstract

Background: Open common femoral endarterectomy (CFAE) is the established treatment for peripheral arterial disease (PAD) affecting the common femoral artery (CFA). However, due to the high prevalence of comorbidities among PAD patients, there is growing interest in minimally invasive endovascular treatments (EVT).

Aims: This study aims to assess the three-year outcomes of EVT in multimorbid PAD patients with severely calcified lesions in the CFA.

Methods: We analysed three-year outcomes for 150 patients who underwent EVT for CFA lesions, using data from the prospective "all-comers" Duesseldorf PTA Registry. Between January 2017 and October 2023, 66 patients received directional rotational atherectomy (DRA) followed by drug-coated balloon (DCB) angioplasty, while 84 patients were treated with DCB alone.

Results: All procedures targeted the CFA, with 49% also involving the proximal superficial femoral artery (SFA) and 10% involving the profunda femoris artery (PFA). The procedural success rate was 97%, consistent across all PAD stages, with higher stent usage in the DCB group (58% vs. 39%, p<0.05). At one year, the primary patency rates were 83% for DRA+DCB and 87% for DCB (p=0.576), and secondary patency was 97% after three years. The three-year major adverse limb event (MALE) rate was driven largely by cdTLR (DRA+DCB: 20% vs. DCB: 14%, p=0.377), with low rates of major amputation in both groups (DRA+DCB: 3% vs. DCB: 1%). The overall major adverse cardiovascular event (MACE) rate at three years was also low (DRA+DCB: 5% vs. DCB: 11%, p=0.170).

Conclusion: EVT offers a safe and effective treatment option for severely calcified lesions in the CFA. It demonstrated high patency rates over a three-year period, along with low incidences of MALE and MACE. Findings from this registry indicate that vessel preparation using DRA can help reduce the need for stenting.

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