Acute Procedural Outcomes of Orbital Atherectomy for the Treatment of Profunda Femoris Artery Disease: Subanalysis of the CONFIRM Registries.

Objective: We compared the angiographic outcomes of patients treated with orbital atherectomy for profunda femoris artery (PFA) and superficial femoral artery (SFA) disease from the CONFIRM I-III registries.

Background: Endovascular revascularization of the PFA is considered a high-risk procedure given that it is an important collateral vessel when the SFA becomes occluded. Data on outcomes of endovascular revascularization of calcified PFA disease are limited.

Methods: The treatment of PFA disease with orbital atherectomy has not been previously reported. Patient demographics, lesion characteristics, and procedure data for all CONFIRM patients with at least one PFA lesion location (n = 33 patients; n = 33 lesions) were compared to patients with at least one SFA lesion location (n = 1574 patients; n = 1811 lesions). The primary endpoint was angiographic complication, defined as the composite of flow-limiting dissection, perforation, slow flow, vessel closure, spasm, embolism, or thrombosis.

Results: The PFA group had a shorter lesion length, larger residual stenosis, shorter total run time, and shorter inflation time. Adjunctive stenting was only performed in the SFA group (10%); no patient in the PFA group underwent stenting. The primary endpoint was low in the PFA group and compared favorably with the SFA group (3% vs 11%; P=.15). One patient in the PFA group had vessel spasm, while no patients had flow-limiting dissection, perforation, slow flow, vessel closure, embolism, or thrombus.

Conclusions: Orbital atherectomy of the PFA was feasible and safe. A randomized trial is needed to determine the ideal treatment strategy for calcified PFA disease.