Phoenix Atherectomy in Calcified Common Femoral and Popliteal Artery Chronic Total Occlusion. A Retrospective Cohort Study.

Introduction: To study the short-term safety, procedural success and efficacy of Phoenix atherectomy in calcified, high TASC CFA and PA chronic total occlusions.

Methods: In this single center retrospective study, we included all patients who underwent Phoenix atherectomy for their calcified CFA and PA CTOs from 2021 to 2023 at Monument Health Rapid City Hospital, Rapid City, South Dakota.

Results: The final cohort consisted of 51 patients, 22 presenting with chronic limb threatening ischemia and 29 with claudication and 51 limbs. Twelve CFA, 25 PA, 4 combined CFA and PA, 5 combined PA and superficial femoral artery [SFA], 5 combined CFA, SFA and PA CTOs were included, half of the lesions were severely calcified, 11 were TASC B, 37 were TASC C and 2 were TASC D lesions. Intravascular ultrasound was performed in half of the patients and drug coated balloons was used in all the patients. Procedural success was achieved in 100% of the patients [residual stenosis of less than 30%], one bail-out covered stenting for a distal popliteal artery perforation, no distal embolization protection devices was used and there were no embolization events. There were no immediate post procedural complications [less than 24 hours]. One death occurred 20 days later from an acute coronary syndrome. At 6 weeks follow-up, 60% had complete resolution of claudication and 40% achieved wound healing with no major amputation. Average peak systolic velocity of the CFA and PA was 214 cm/s and 91 cm/s, respectively with PSVR of less than 2.4 at 6 weeks' follow-up. Clinically driven target lesion revascularization occurred in 3 patients at 4, 5 and 6 months after the index procedure.

Conclusions: Phoenix atherectomy can be used safely and effectively in calcified, high TASC common femoral and popliteal artery chronic total occlusions with extremely low rates of bail-out stenting and other complications and reasonable clinical efficacy.