Introduction:

The optimal treatment of common femoral artery (CFA) atherosclerotic disease remains controversial. While open endarterectomy is considered the gold standard, it is associated with surgical morbidity and wound complications.

Intravascular lithotripsy (IVL) offers a minimally invasive alternative that fractures vascular calcium without the need for permanent stent implantation.

Objective:

To evaluate early and midterm outcomes of endovascular treatment of primary common femoral artery (CFA) atherosclerotic disease with intravascular lithotripsy (IVL).

Study:

Prospective, multicentre, observational registry (FESTIVAL).

Population:

• 117 patients were enrolled between January 2024 and February 2025
• Rutherford class 3 — 6
• de novo CFA lesion (Azéma type I — III)
• Possible adjunctive endovascular treatment of iliac, femoral, popliteal, and or tibial vessels
• Possible post-dilatation with plain or drug-coated balloon angioplasty (no stenting)

Outcomes:

• Primary outcome:
  • Primary patency
  • Primary-assisted patency
  • Secondary patency
  • Freedom from clinically driven target lesion revascularisation (cdTLR)
  • Freedom from any reintervention at 1 year and 2 years
• Secondary outcome:
  • Profunda femoris patency
  • Limb salvage

Key findings:

• Technical success was achieved in 97.4% of cases, with no procedure-related mortality, vessel rupture, or major adverse cardiovascular events within 30 days
   
• Estimated 1- and 2-year outcomes were respectively: primary patency 96.2% and 93.9%;
  • primary-assisted patency 96.2% a=; nd 93.9%;
  • secondary patency 100% and 100%;
  • freedom from cdTLR 95.2% and 92.6%
  • and freedom from reintervention 96.2% and 91.9%. 
     
• Profunda femoris patency was 99.1% and limb salvage reached 97.7% at 2 years.