title: Percutaneous common femoral artery interventions using angioplasty, atherectomy, and stenting.
abstract: BACKGROUND
  This study evaluated the feasibility, safety, and effectiveness of endovascular interventions for common femoral artery (CFA) occlusive disease.
  
  
  METHODS
  Using a prospectively maintained multicenter database, we analyzed outcomes in 167 consecutive patients who underwent percutaneous CFA interventions for Rutherford class 3 to class 6 (R3-R6) disease. The standardized treatment approach included primary percutaneous transluminal angioplasty (PTA) only, atherectomy + PTA, and provisional stenting. Outcomes included technical failure rate, recurrence, complications, and major or minor amputation rate. Data were analyzed using multivariate regression analysis.
  
  
  RESULTS
  During a 7-year period, 167 patients with R3 (n = 91 [54.5%]) and R4 to R6 (n = 76 [45.5%]) disease underwent CFA interventions that included PTA only (n = 114 [68.2%]), atherectomy ± PTA (n = 38 [22.8%]), and provisional stenting (n = 15 [9.0%]) for failed atherectomy ± PTA. Procedure-related complications included pseudoaneurysm (n = 1 [0.6%]), thrombosis (n = 1 [0.6%]), distal embolization (n = 1 [0.6%]), and death (R6, n = 1 [0.06%]). CFA restenosis was observed in 34 (20.4%) patents; these underwent further percutaneous (n = 18 [10.8%]) or surgical (n = 17 [10.2%]) revascularization that included CFA endarterectomy ± femoral distal bypass. Major or minor amputations were observed in none of the R3 patients and in only three (3.9%) and five (6.5%) of the R4 to R6 patients, respectively. Compared with the atherectomy + PTA group, patients in the PTA-only group had a significantly lower patency. Furthermore, during long-term mean follow-up of 42.5 months, the CFA provisional stent group had a 100% primary patency, which was significantly better than the primary patency in the CFA nonstent groups combined (77.0%; P = .0424).
  
  
  CONCLUSIONS
  Data from this study to date would suggest that percutaneous CFA interventions in select patients are relatively safe and effective. In the long term, CFA stenting has significantly better primary patency than CFA atherectomy and PTA combined. CFA atherectomy + PTA has significantly better primary patency than CFA PTA-only at midterm, especially in patients with claudication. Future randomized controlled trials are warranted.
authors.affiliation: Department of Surgery, Albany Medical College, Albany, NY; Vascular Health Partners of Community Care Physicians, PC, Albany, NY. Electronic address: mmehta@vascularhealthpartners.com.
authors.forename: Manish
authors.initials: M
authors.lastname: Mehta
authors.affiliation: Department of Surgery, Albany Medical College, Albany, NY.
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Surgery, Albany Medical College, Albany, NY; Vascular Health Partners of Community Care Physicians, PC, Albany, NY.
authors.forename: Philip S K
authors.initials: PS
authors.lastname: Paty
authors.affiliation: Department of Surgery, Albany Medical College, Albany, NY.
authors.forename: Medhi
authors.initials: M
authors.lastname: Teymouri
authors.affiliation: Department of Surgery, Albany Medical College, Albany, NY.
authors.forename: Kamran
authors.initials: K
authors.lastname: Jafree
authors.affiliation: Department of Surgery, Albany Medical College, Albany, NY.
authors.forename: Humayun
authors.initials: H
authors.lastname: Bakhtawar
authors.affiliation: The Vascular Group PLLC, Albany, NY.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hnath
authors.affiliation: Center for Neuropharmacology and Neuroscience, Albany Medical College, Albany, NY.
authors.forename: Paul
authors.initials: P
authors.lastname: Feustel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D017073:Atherectomy / Q000009:adverse effects / Q000401:mortality; D016208:Databases, Factual; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D017211:Treatment Failure; D014654:Vascular Patency