1. Common Femoral Artery Disease: When is Endovascular Therapy Appropriate
Michael Siah, M.D.
Medstar Georgetown University Hospital
Medstar Washington Hospital Center
Washington, D.C.

2. Disclosure
No financial disclosures

3. Common Femoral Artery Disease
Asymptomatic disease very uncommon
Most patients with CLI or severe claudication
May be associated with graft occlusion and clot propagation
Advanced atherosclerosis

4. Common Femoral Artery Disease
Usually requires intervention
Preservation of the profunda is paramount
Ostium
Distal embolization

5. Common Femoral Artery Disease: Challenges
Anatomy: Location
Geometry: Bifurcation
Access Difficulty
Disease Severity

6. Common Femoral Artery Disease: Challenges
Anatomy: Location
Inguinal Ligament
Flexion
Geometry: Bifurcation
Access Difficulty
Disease Severity

7. Common Femoral Artery Disease: Challenges
Anatomy: Location
Inguinal Ligament
Flexion
Geometry: Bifurcation
SFA, Profunda – Equally important
Access Difficulty
Disease Severity

8. Common Femoral Artery Disease: Challenges
Anatomy: Location
Inguinal Ligament
Flexion
Geometry: Bifurcation
SFA, Profunda – Equally important
Access Difficulty
Contralateral Femoral, Brachial
Disease Severity

9. Common Femoral Artery Disease: Challenges
Anatomy: Location
Inguinal Ligament
Flexion
Geometry: Bifurcation
SFA, Profunda – Equally important
Access Difficulty
Contralateral Femoral, Brachial
Disease Severity
Inflow Lesion

10. Common Femoral Artery Disease: Percutaneous Endovascular Treatment
POBA
Atherectomy
Stenting

11. Common Femoral Artery Disease: Rationale for Surgery
POBA
Atherectomy
Stenting
Excellent Results with Surgery

12. Common Femoral Artery Disease: Surgical Options
Endarterectomy
Bypass
Cross Femoral Bypass
Ilio-Femoral Bypass
Aorto-Femoral Bypass
Axillo-Femoral Bypass
With concomitant
aorto-iliac disease

13. CFA Endarterectomy May be performed under local anesthesia
Can combine with outflow operation (fem-pop, fem-tibial bypass)
Well tolerated – usual LOS 1-2 days
Allows for profundaplasty
Allows for graft preservation
Excellent results
>90% patency at 5 years

14. Multiple failed AV grafts L thigh AV graft poor function
40 yo male, ESRD
Multiple failed AV grafts
L thigh AV graft poor function
Gangrene L foot
35 mm gradient

15. with patch angioplasty
Endarterectomy
with patch angioplasty

16. 83 yo male, former heavy smoker, diabetes, ESRD
2 months of rest pain left foot
Nonpalpable femoral and distal pulses
ABI 0.2

28. 9 MONTHS LATER: DEVELOPED SIMILAR SYMPTOMS
ABSENT FEMORAL PULSE

30. Post scoring balloon
angioplasty

31. Combined Surgical and Endovascular Treatment
71 yo male, ESRD, on dialysis, smoker, diabetes
Ulceration on forefoot and lower leg
Nonpalpable femoral and distal pulses

38. Common Femoral Artery Disease: Percutaneous Endovascular Treatment
Despite its theoretical disadvantages, PEI of the Common Femoral Artery should be part of the overall vascular treatment armamentarium.

39. Common Femoral Artery Disease: Percutaneous Endovascular Treatment
Stenting not an option
Avoid dissection
POBA may be suboptimal
Atherectomy – with distal embolic protection if possible

41. Rationale for Atherectomy
Debulking the plaque
Change vessel compliance
Reduce need for adjunctive stenting
May even reduce need for angioplasty
Compliance change enables lower pressure adjunctive balloon angioplasty
Less dissection
Less “uncontrolled damage”
?Better patency?

42. Rationale for Atherectomy
Debulking the plaque
Change vessel compliance
Reduce need for adjunctive stenting
May even reduce need for angioplasty
Compliance change enables lower pressure adjunctive balloon angioplasty
Less dissection
Less “uncontrolled damage”
?Better patency?

43. Rationale for Atherectomy
Debulking the plaque
Change vessel compliance
Reduce need for adjunctive stenting
May even reduce need for angioplasty
Compliance change enables lower pressure adjunctive balloon angioplasty
Less dissection
Less “uncontrolled damage”
?Better patency?

48. Conclusion
Disease of the common femoral artery poses unique challenges for “conventional” percutaneous endovascular treatment.
Surgical treatment, especially endarterectomy, is safe, effective, and quite durable.

49. Newer technology will expand the endovascular options.
Conclusion
Endovascular interventions on the common femoral artery can also be successful, sage, and effective in the appropriate patient when performed by the appropriate clinician, with the appropriate tools.
Newer technology will expand the endovascular options.

50. Conclusion
Ultimately, both surgical and endovascular treatments should be within the toolbox of the experienced and skilled interventionalist.