Efficacy of the decalcification of heavily calcified femoral bifurcation lesions using a Cavitron Ultrasonic Surgical Aspirator.

OBJECTIVES In the current diabetes era, severe calcified femoral bifurcation lesions extending to the external elastic lamina are sometimes experienced and are technically challenging during conventional endarterectomy. We previously reported an alternative method, a decalcification technique with a Cavitron Ultrasonic Surgical Aspirator (CUSA), for calcified lesions. This study aimed to clarify the efficacy of CUSA decalcification technique. METHODS Twenty-six limbs treated with CUSA decalcification from 2014 to 2017 were enrolled and evaluated hemodynamically with ankle brachial index (ABI) and morphologically with computed tomography angiography (CTA). ABI was measured every 6 months, and CTA was performed early after surgery and then annually thereafter. Curved planar reformation images and cross-sectional multiplanar reconstruction images obtained by CTA were employed to measure cross-sectional area of common femoral artery (CFA). Then, the time courses of ABI and CFA areas were analyzed. RESULTS The operative indication was claudication in 80.8%, rest pain in 7.7%, and tissue loss in 11.5% of the cases. A concomitant profundaplasty was performed in 34.6% of the cases. One case of an intraoperative arterial wall perforation was experienced as a procedure-related complication. Hemodynamic success rate was 96.2% (preoperative ABI: 0.37 ± 0.28, postoperative ABI: 0.75 ± 0.15, p 50% decrease in cross-sectional area. CONCLUSIONS CUSA decalcification is a safe and effective alternative method to treat heavily calcified femoral lesions with a good patency rate and a low restenosis rate.