Three‐year outcome of directional atherectomy and drug coated balloon for the treatment of common femoral artery steno‐occlusive lesions

Background Endarterectomy is considered the gold standard therapy for common femoral artery (CFA) steno‐occlusive lesions, but a significant risk of perioperative mortality and complications has been reported. Objective Aim of this study is to evaluate the efficacy at a long‐term follow‐up of patients with CFA steno‐occlusive lesions treated with directional atherectomy and drug coated balloon (DCB). Material and methods In this single‐center registry, 78 patients (male: 80.7%; age: 71 ± 15 years; occlusions: 25%) with 80 CFA lesions were included, with 39.7% of them undergoing directional atherectomy and drug coated balloon due to critical limb ischemia and 60.3% due to lower‐limb intermittent claudication. The long‐term follow‐up was completed by 75 patients (3 years). The 31 patients with critical ischemia (39.7%) were further subdivided into 20 (25.6%) patients with pain at rest and 11 (14.1%) with trophic changes, ulcers and/or tissue loss. We considered the primary and the secondary outcome, referring, respectively to peak systolic velocity ratio (PSVR) ≥ 2.4 on duplex or > 50% stenosis on digital subtraction angiography at 36 months and to clinically driven target lesion revascularization at 36 months. Results The primary and secondary outcome was obtained in 84% and 86.7% of patients, at 36 months of follow up. Bailout stenting was necessary in 6/80 cases (7.5%) for suboptimal result. Freedom from MALE was obtained in 98.6% of patients. Conclusions These results confirm that directional atherectomy and drug coated balloon strategy for the treatment of CFA lesions is effective at a long‐term follow‐up and could be considered as a good alternative to surgery.