Endovascular treatment of calcific lesions of the common femoral artery using atherectomy device associated with scoring balloon angioplasty in diabetic patients with high “major amputation” risk

Objectives To investigate the outcomes of patients with calcific lesions in the common femoral artery undergoing endovascular procedures with atherectomy device and scoring balloon angioplasty combined with treatment of steno-occlusive disease of the remaining arterial districts of the lower limb. Methods Between January 2015 and December 2018, 11 diabetic patients at high risk for “major amputation”, with calcific lesions of the common femoral artery and ischemic ulcers requiring endovascular treatment were retrospectively evaluated. Technical success was defined as revascularization of the common femoral artery with a residual stenosis lower than 30%. Primary endpoints were an immediate increase of perilesional transcutaneous oxygen pressure (TCPO2) > 40 mmHg, ulcerative lesions improvement up to healing or skin flaps re-epithelialization after minor amputation, limb rescue with rejected major amputation, and resolution of rest pain if present. Results The success rate of the revascularization procedures was 100%. No patient underwent surgical conversion. One case of peri-operative bleeding at the brachial access site was observed. There were no cases of arterial dissection or undesired distal embolization. The average baseline value of perilesional TCPO2 was 21.8 ± 9.2 mmHg. The mean TCPO2 value was 57.4 ± 7.2 mmHg three days after the procedure ( P < 0.05), and 51.2 ± 9.8 mmHg 15 days after ( P < 0.05). Minor amputations were performed in five patients with advanced ulcerative lesions. No major amputations were performed in the follow-up period. At 14 months follow-up, one patient developed new occlusion of the CFA for extension from the external iliac artery and underwent a new endovascular procedure. We observed an overall primary patency rate of 91% and a primary assisted patency rate of 100% in our 18-month follow-up. Conclusions Endovascular approach for severely calcified atherosclerotic lesions of the common femoral artery seems to represent a valid therapeutic option associated with promising results in terms of clinical outcome and low complication rates.

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The “Fracking” technique: a novel approach to crack deep calcified plaque in the common femoral artery with hydraulic pressure

CVIR Endovascular ◽

10.1186/s42155-021-00258-y ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Takuya Haraguchi ◽

Tsutomu Fujita ◽

Yoshifumi Kashima ◽

Masanaga Tsujimoto ◽

Tsuyoshi Takeuchi ◽

...

Keyword(s):

Clinical Outcomes ◽

Femoral Artery ◽

Balloon Angioplasty ◽

Common Femoral Artery ◽

Hydraulic Pressure ◽

Lumen Area ◽

Minimal Lumen Area ◽

Calcified Plaque ◽

The Common

Abstract Background The patency achieved by conventional peripheral interventions for atherosclerotic lesions in the common femoral artery (CFA), called the “no stenting zone”, is not superior to that achieved by surgical endarterectomy due to calcified plaque occupying the area. Plaque modification strategies to obtain acute gain in CFA patency provide the better clinical outcomes than standard balloon angioplasty. Atherectomy devices, which focus on the modification of superficial calcifications, contribute to the improvement of clinical outcomes. However, deep calcifications resist vessel expansion such that luminal gain is not easily achieved. Main text We propose a novel calcified plaque modification technique, named the “fracking technique” (FT). The term fracking refers to how a rock is fractured by the high hydraulic pressure. In this technique, deep calcifications are cracked with hydraulic pressure via a balloon indeflator through an 18-gauge needle, which punctures calcifications to achieve greater acute luminal gain. Case 1 involved an 81-year-old male with eccentric calcified plaque in the right CFA. Conventional balloon angioplasty for the lesion yielded a suboptimal minimal lumen area (MLA), which increased from 6.2 to 10.7-mm2 on intravascular ultrasound (IVUS). The FT was implemented to obtain a larger MLA. After the FT was repeated at three locations at up to 8-atm, a greater MLA of 27.1-mm2 was achieved without complications. Case 2 involved a 72-year-old male undergoing hemodialysis due to diabetes mellitus who presented with ischemic pain in his right limbs at rest due to severe stenosis with eccentric calcification in the distal CFA. The MLA on IVUS before and after balloon angioplasty was 10.0-mm2 and 13.1-mm2, respectively, and this result was still suboptimal. The FT was attempted and successfully yielded a greater MLA of 28.9-mm2 without complications. Restenosis has not been detected for 2 years follow-up period. Conclusions The FT is an effective option for treating calcified CFA lesions to achieve a larger lumen area. Long-term follow-up studies are necessary.

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Direct Bare Metal Needle Puncture and Balloon Angioplasty in Calcified Plaques of the Common Femoral Artery Guided by Angiography (“BAMBOO SPEAR”)

10.21203/rs.3.rs-173348/v1 ◽

2021 ◽

Author(s):

Naoki Hayakawa ◽

Satoshi Kodera ◽

Masataka Arakawa ◽

Satoshi Hirano ◽

Sandeep Shakya ◽

...

Keyword(s):

Femoral Artery ◽

Balloon Angioplasty ◽

Common Femoral Artery ◽

Lower Limbs ◽

Bare Metal ◽

Needle Puncture ◽

Total Occlusion ◽

Calcified Plaque ◽

The Common ◽

Metal Needle

Abstract BackgroundSurgical endarterectomy for common femoral artery (CFA) disease is still considered the gold standard for treatment. Development of various techniques and devices has improved the clinical results of endovascular therapy (EVT) for CFA. However, severe conditions remain, especially for occlusive lesions owing to calcified plaque. We developed a useful technique for passing a lesion by directly penetrating the calcified plaque of the CFA using a bare metal needle and then passing through a balloon or dilating it. We named this technique “direct bare metal needle puncture and balloon angioplasty in calcified plaques of the common femoral artery guided by angiography” or “BAMBOO SPEAR.” Main textThis report describes our technique for crossing a lesion by directly penetrating the calcified plaque of the CFA using a needle. We report a case of a 73-year-old male with hemodialysis who presented with cyanosis and ischemic rest pain of both lower limbs. Control angiography showed total occlusion of the left CFA with a calcified plaque. We advanced a 21-G metal needle that was slightly curved into the blood vessel from where the lumen of the distal CFA was located. The needle was advanced into the center of the calcified plaque, while observing from multiple directions with a fluoroscopic guide. We succeeded in advancing the needle into the lumen of the distal external iliac artery. After guidewire crossing, intravascular ultrasound (IVUS) showed that guidewire was able to completely pass through the center of the calcified plaque. We could dilate the lesion by scoring balloon and drug-coated balloon. The final angiography showed sufficient results. We named this technique ‘‘direct BAre Metal needle puncture and BallOOn angioplaSty in calcified PlaquEs of the common femoral ARtery guided by angiography” (BAMBOO SPEAR).ConclusionsThe BAMBOO SPEAR technique may be considered a useful option in EVT for occlusive CFA with calcified plaques.

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Direct bare metal needle puncture and balloon angioplasty in calcified plaques of the common femoral artery guided by angiography (“BAMBOO SPEAR”)

CVIR Endovascular ◽

10.1186/s42155-021-00217-7 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Naoki Hayakawa ◽

Satoshi Kodera ◽

Masataka Arakawa ◽

Satoshi Hirano ◽

Sandeep Shakya ◽

...

Keyword(s):

Femoral Artery ◽

Balloon Angioplasty ◽

Common Femoral Artery ◽

Lower Limbs ◽

Bare Metal ◽

Needle Puncture ◽

Total Occlusion ◽

Calcified Plaque ◽

The Common ◽

Metal Needle

Abstract Background Surgical endarterectomy for common femoral artery (CFA) disease is still considered the gold standard for treatment. Development of various techniques and devices has improved the clinical results of endovascular therapy (EVT) for CFA. However, severe conditions remain, especially for occlusive lesions owing to calcified plaque. We developed a useful technique for passing a lesion by directly penetrating the calcified plaque of the CFA using a bare metal needle and then passing through a balloon or dilating it. We named this technique “direct bare metal needle puncture and balloon angioplasty in calcified plaques of the common femoral artery guided by angiography” or “BAMBOO SPEAR.” Main text This report describes our technique for crossing a lesion by directly penetrating the calcified plaque of the CFA using a needle. We report a case of a 73-year-old male with hemodialysis who presented with cyanosis and ischemic rest pain of both lower limbs. Control angiography showed total occlusion of the left CFA with a calcified plaque. We advanced a 21-G metal needle that was slightly curved into the blood vessel from where the lumen of the distal CFA was located. The needle was advanced into the center of the calcified plaque, while observing from multiple directions with a fluoroscopic guide. We succeeded in advancing the needle into the lumen of the distal external iliac artery. After guidewire crossing, intravascular ultrasound (IVUS) showed that guidewire was able to completely pass through the center of the calcified plaque. We could dilate the lesion by scoring balloon and drug-coated balloon. The final angiography showed sufficient results. We named this technique “direct BAre Metal needle puncture and BallOOn angioplaSty in calcified PlaquEs of the common femoral ARtery guided by angiography” (BAMBOO SPEAR). Conclusions The BAMBOO SPEAR technique may be considered a useful option in EVT for occlusive CFA with calcified plaques.

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Directional Atherectomy of the Common Femoral Artery. Learning Curve and One Year Follow up

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2019.09.295 ◽

2019 ◽

Vol 58 (6) ◽

pp. e744-e745

Author(s):

Fernando Picazo ◽

Ricky Kwok ◽

Joseph A. Hockley ◽

Marek Garbowski ◽

Shaun Samuelson ◽

...

Keyword(s):

Learning Curve ◽

Femoral Artery ◽

Common Femoral Artery ◽

Directional Atherectomy ◽

The Common ◽

One Year

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Open Subintimal Angioplasty of the Superficial Femoral and Distal Arteries

Journal of Endovascular Therapy ◽

10.1177/152660280000700109 ◽

2000 ◽

Vol 7 (1) ◽

pp. 68-71 ◽

Cited By ~ 6

Author(s):

Panagiotis Balas ◽

Nicolas Pangratis ◽

Nikos Ioannou ◽

Photis Milas ◽

Christos Klonaris ◽

...

Keyword(s):

Femoral Artery ◽

Common Femoral Artery ◽

Open Approach ◽

Subintimal Angioplasty ◽

Arterial Lumen ◽

Long Term Follow Up ◽

Patch Graft ◽

The Common

Purpose: To describe an open approach to subintimal angioplasty. Technique: Through a subinguinal incision and arteriotomy over the superficial femoral artery origin, the opening of a subintimal channel is created surgically. The subintimal plane is advanced distally with a guidewire, and this neolumen is expanded with sequential balloon dilations. The atherosclerotic core is dissected proximally in the common femoral artery and tacked down to ensure inflow. A patch graft closes the arteriotomy. Conclusions: Open subintimal angioplasty is a simple, minimally invasive alternative treatment for complete SFA occlusion. Long-term follow-up in a large group of patients will be necessary to determine the durability of the false arterial lumen.

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Kissing Stents in the Common Femoral Artery Bifurcation for Critical Limb Ischemia: Technical Description and Report of Three Cases

Vascular ◽

10.2310/6670.2007.00037 ◽

2007 ◽

Vol 15 (4) ◽

pp. 211-214 ◽

Cited By ~ 12

Author(s):

Sven Ross Mathisen ◽

Michael Åkesson ◽

Mats Lindh ◽

Krassi Ivancev ◽

Timothy A. Resch

Keyword(s):

Femoral Artery ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Common Femoral Artery ◽

Short Term ◽

Number Of Patients ◽

The Common ◽

Kissing Stent ◽

Patch Plasty

The purpose of this article is to describe three cases of kissing stent placement in the common femoral artery bifurcation in patients unsuitable for open endarterectomy and patch plasty. In three patients with critical limb ischemia, caused by primary atherosclerotic disease or dissection-related injury when performing a lower extremity intervention, a technique of kissing stents was used to treat the flow-obstructing lesion in the common femoral artery bifurcation. Technical success was uniform, and during follow-up (4.5–8 months), all patients showed improved symptoms, wound healing, and duplex ultrasonography–verified patency of the stents. Kissing stents in the common femoral artery bifurcation are a feasible treatment option in patients with limited mobililty or contraindications to open repair. The short-term results seem promising, but longer follow-up and an increased number of patients will be needed to assess the durability of the reconstruction.

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Initial Experience with Percutaneous Angioplasty of the Common Femoral Artery in De Novo Stenotic Lesions

Annals of Vascular Surgery ◽

10.1016/j.avsg.2015.05.002 ◽

2015 ◽

Vol 29 (8) ◽

pp. 1493-1500 ◽

Cited By ~ 11

Author(s):

Romain de Blic ◽

Jean-François Deux ◽

Hicham Kobeiter ◽

Pascal Desgranges ◽

Jean-Pierre Becquemin ◽

...

Keyword(s):

Femoral Artery ◽

De Novo ◽

Common Femoral Artery ◽

Initial Experience ◽

Percutaneous Angioplasty ◽

The Common ◽

Stenotic Lesions

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Anomalous High Bifurcation of the Common Femoral Artery at the Groin: Management of Gsv Incompetence with Endovenous Laser Ablation

Phlebology The Journal of Venous Disease ◽

10.1258/phleb.2012.012047 ◽

2012 ◽

Vol 28 (5) ◽

pp. 264-267 ◽

Cited By ~ 1

Author(s):

C Lekich ◽

W Campbell ◽

S Walton ◽

P Hannah

Keyword(s):

Laser Ablation ◽

Femoral Artery ◽

Vascular Complications ◽

Common Femoral Artery ◽

Vascular Anomalies ◽

Endovenous Laser Ablation ◽

Safe Treatment ◽

Complications Of Surgery ◽

The Common ◽

Saphenofemoral Junction

Objectives: To discuss safety of EVLA in anomalies of the GSV anatomy. To review and discuss complications of surgery involving anomalous anatomy. Method: We report a case of high bifurcation of the common femoral artery wrapping around the saphenofemoral junction. Results: Successful ablation was achieved with no adverse consequences. Conclusion: EVLA is a safe treatment for SFJ/GSV incompetence in the presence of vascular anomalies that have historically resulted in serious vascular complications from surgery.

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