Application of the Fracking hydraulic rupture technique in chronic calcified occlusion of the common femoral artery
NEW TECHNOLOGIES IN MEDICINE
Abstract
The patency achieved by conventional peripheral interventions for atherosclerotic lesions in the common femoral artery (CFA), called the "no stenting zone", is not superior to that achieved by surgical endarterectomy due to calcified plaque occupying the area. Plaque modification strategies to obtain acute gain in CFA patency provide the better clinical outcomes than standard balloon angioplasty. Atherectomy devices, which focus on the modification of superficial calcifications, contribute to the improvement of clinical outcomes. However, deep calcifications resist vessel expansion such that luminal gain is not easily achieved. This case report demonstrates the successful application of the “Fracking” technique (hydraulic plaque disruption) for recanalizing a heavily calcified chronic occlusion of the common femoral artery (CFA) in a 61-year-old male patient presenting with critical limb ischemia (CLI) of the left lower extremity and a trophic ulcer at the Limb Salvage Center (St. Petersburg State Healthcare Institution "City Hospital No. 14"). Conventional antegrade and retrograde endovascular recanalization attempts failed. Under fluoroscopic guidance, direct percutaneous puncture of the occluded CFA segment was performed using an 18G needle connected to an inflation device. Controlled injection of contrast medium at low pressure (2–3 atm) created dissection planes within the calcified plaque, establishing a channel. Subsequent antegrade balloon angioplasty of the CFA and stenting of the external iliac artery restored flow, resolving rest pain and enabling healing of the trophic ulcer. This technique represents a viable endovascular salvage option for calcified occlusions resistant to standard methods and can serve as an alternative to open surgery when contraindicated.
References
1. Norgren L., Hiatt W.R., Dormandy J.A. et al. Inter-Society Consensus on the Management of Patients with Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007:45(Suppl S):S5-67. https://doi.org/10.1016/j.jvs.2006.12.037.
2. Кучай А.А., Липин А.Н., Груздев Н.Н., Борисов А.Г., Ширан В.А., Курач М. Заболевание периферических артерий нижних конечностей: современная эпидемиология, руководство и перспективные направления (научное сочинение). Российские биомедицинские исследования. 2023;8(4):54–64. https://doi.org/10.56871/RBR.2023.32.30.007
3. Rocha-Singh K.J., Zeller T., Jaff M.R. Peripheral arterial calcification: prevalence, mechanism, detection, and clinical implications. Catheter Cardiovasc Interv. 2014;83(6):E212-20. https://doi.org/10.1002/ccd.25387.
4. Кучай А.А., Липин А.Н. и др.. Гибридный подход в лечении протяженных окклюзий артерий нижних конечностей при КИНК. Ангиология и сосудистая хирургия. Журнал им. академика А.В. Покровского. 2019;25(S2):260–264. EDN: QWXIPN.
5. Gandhi R.T., Benenati J.F., Baumann D.S. et al. Fracking: a new approach to percutaneous treatment of severely calcified lesions in the femoropopliteal segment. J Endovasc Ther. 2017;24(1):112–118. https://doi.org/10.1177/1526602816664881.
6. Shishehbor M.H., Jaff M.R., Gray B.H. et al. Critical limb ischemia: current issues and prospects. Ann Vasc Surg. 2019;13(4):45–58.
7. Кучай A.A., Липин А.Н., Курьянов П.С., Груздев Н.Н., Атмадзас К.А., Карелина Н.Р., Артюх Л.Ю. Концепция дистального гибридного вмешательства при атеросклеротическом поражении артерий нижних конечностей. Атеросклероз и дислипидемии. 2023;(3(52)):37–43. https://doi.org/10.34687/2219-8202.JAD.2023.03.0005.
8. Кучай А.А., Липин А.Н., Падариа Ш.Ф., Груздев Н.Н., Борисов А.Г., Мухамедов Х.А., Ходжакулиев Г.Б., Ревякин А.А. Хроническая ишемия, угрожающая потерей конечности, — эпидемиология, патогенез, диагностика и стратегии лечения. Российские биомедицинские исследования. 2024;9(3),53–61. https://doi.org/10.56871/RBR.2024.95.99.007.
9. Kawarada O., Zen K., Hozawa K. et al. Modern interventions on the arteries of the lower leg for limb salvage: current concepts and perspectives. Cardiol Cardiovasc Surg. 2019;42(1):15–24.
10. Кучай А.А., Липин А.Н., Курьянов П.С. Преимущества техники гибридной реваскуляризации при лечении протяженных окклюзий поверхностной бедренной артерии и многоуровневых поражений артерий нижних конечностей. Регионарное кровообращение и микроциркуляция. 2024;23(2):60–66. https://doi.org/10.24884/1682-6655-2024-23-2-60-66.
11. Bausback Y., Botsios S., Flux J. et al. Outback catheter for recanalization of chronic total occlusions of the femoropopliteal segment: experience of one center. J Endovasc Ther. 2013;20(1):56–62.
12. Kuchay A.A., Lipin A.N., Padaria Sh.F., Gruzdev N.N. Arterial restenosis: past, current status and future directions. J Chronic Dis Prev Care. 2024;1(1):1–8. https://doi.org/10.33425/3065-7059-1004.
13. Schmidt A., Ulrich M., Winkler B. et al. Angiographic patency and clinical outcomes after balloon angioplasty in extensive lower leg artery disease. Catheter Cardiovasc Interv. 2010;76(7):1047–1054. https://doi.org/10.1002/ccd.22658.
14. Кучай А.А., Липин А.Н. Гибридные вмешательства на дистальных отделах магистральных артерий при протяженных хронических окклюзиях поверхностной бедренной артерии у пациентов с критической ишемией конечностей. Атеросклероз и дислипидемии. 2024;(2(55)):32–40. https://doi.org/10.34687/2219-8202.JAD.2024.02.0004.
15. Кучай А.А., Липин А.Н., Груздев Н.Н., Борисов А.Г., Кашапов И.С. Критическая ишемия нижних конечностей и ее лечение. Российские биомедицинские исследования. 2024;9(1):34–47. https://doi.org/10.56871/RBR.2024.68.81.005.
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