Mid-term outcomes of percutaneous atherectomy of common femoral arterial lesions.

OBJECTIVE: To evaluate the mid-term clinical and angiographic outcomes of primary percutaneous atherectomy for isolated atherosclerotic lesions of the common femoral artery (CFA). METHODS: This retrospective, single-center study included 49 patients (50 limbs) who underwent directional or rotational atherectomy between January 2017 and December 2025. The cohort was elderly (mean age 71.9 ± 6.9 years) and high risk, with 55.1% presenting with chronic limb-threatening ischemia. Severe calcification (>50% circumference) was observed in 73.5% of lesions. The primary endpoint was primary patency, defined as freedom from ≥50% restenosis or target lesion revascularization (TLR), assessed by duplex ultrasound up to five years. RESULTS: Technical success (<30% residual stenosis) was achieved in 98.0%. Bailout stenting was required in 6.1%. The ankle-brachial index improved from 0.66±0.19 to 0.95±0.19 (P < 0.001). Primary patency rates were 95.6% and 79.6% at 1 and 3 years, respectively. TLR occurred in 20.0% of lesions during follow-up. Three-year overall survival and limb salvage rates were 90.3% and 97.9%, respectively. The 30-day major complication rate was 0.0%, with a single minor access-site hematoma (2.0%) managed conservatively. The median hospital stay was 1 day (IQR, 1-2 days). CONCLUSIONS: Primary percutaneous atherectomy for isolated CFA lesions demonstrates durable mid-term patency, with outcomes approaching those reported for surgical endarterectomy, while minimizing invasiveness and avoiding permanent implants. These findings suggest that this approach may be considered a feasible alternative in selected high-risk or surgically unsuitable patients.