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Percutaneous common femoral artery interventions viable in select patients
In select patients, common femoral artery stenting appears to be reasonably safe and effective, according to recent findings.
In the longitudinal, intention-to-treat study, researchers reviewed a prospectively maintained multicenter database to identify 167 consecutive patients who underwent percutaneous procedures for Rutherford class 3 to 6 disease between 2006 and 2013.
Standardized treatment options were primary percutaneous transluminal angioplasty (PTA) only (68%), atherectomy plus PTA (23%) and provisional stenting (9%). Although the choice of treatment modality was at the discretion of the physician, patients typically underwent PTA with provisional stenting if the initial common femoral artery lumen was more than 5 mm.
Patients were stratified by Rutherford class into two groups: a claudication group (Rutherford class 3; 55%) and a critical limb ischemia (CLI) group (Rutherford class 4-6; 45%).
After undergoing the procedures, patients were discharged on a 3-month regimen of antiplatelet agents. Routine follow-up occurred at 2 weeks after the procedure and at 6-month intervals thereafter. Postprocedural follow-up assessments included clinical examinations, pulse volume recordings and duplex ultrasound. The study’s primary endpoints were primary patency, technical failure rate, recurrence, procedure-related complications, and major or minor amputations. The researchers used multivariate regression analysis to compare the different treatments within the groups.
Patency data
Among all the patients, the PTA plus atherectomy group had significantly better primary patency vs. the PTA-only group, according to the researchers. An analysis of the data based on treatment indication found that patients with disabling claudication who underwent atherectomy plus PTA had a better primary patency vs. those who underwent PTA only (P = .047). The CLI group did not demonstrate a difference in patency between atherectomy plus PTA and PTA only.
During a mean follow-up of 42.5 months, the researchers found no significant difference in the performance of secondary percutaneous interventions for failure or recurrent disease in the common femoral artery PTA-only group (14%) and the common femoral artery atherectomy plus PTA group (5.3%) and the common femoral artery provisional-stent group (0%). However, at this time point, the common femoral artery provisional group needed secondary percutaneous and surgical interventions less often than the common femoral artery nonstenting groups combined (0% vs. 23%; P = .0424).
Complications
Among the procedural complications noted were pseudoaneurysm (0.6%), thrombosis (0.6%), distal embolization (0.6%) and death (Rutherford class 6; 0.06%). Twenty percent of the patients exhibited common femoral artery restenosis; these patients underwent additional percutaneous (10.8%) or surgical (10.2%) procedures, including common femoral artery endarterectomy with or without femoral distal bypass. None of the Rutherford class 3 patients, three Rutherford class 4 patients and five Rutherford class 6 patients underwent major or minor amputations.
“These data would by no means indicate a change in paradigm when managing patients with symptomatic [common femoral artery] occlusive disease; [common femoral artery] endarterectomy still remains the gold standard.” the researchers wrote. “However, in appropriately selected patients, percutaneous [common femoral artery] interventions are safe and effective, and further multicenter randomized studies will be needed to identify appropriate selection of patients and therapy.” – by Jennifer Byrne
Disclosure: One researcher reports financial ties with Abbott Vascular, Aptus Endosystems, Bolton Medical, Boston Scientific, Medtronic, Silk Road Medical, Terumo Cardiovascular Systems Corp., Trivascular and W. L. Gore.