Common Femoral Artery Intervention: Surgery vs IVL – Dr. Mouawad & Dr. Sayfo

The common femoral artery has always been considered a surgical zone—but with today’s endovascular technology, should that dogma be challenged?In this MurmurMD session, vascular surgeon Dr. Nick Mouawad joins Dr. Sameh Sayfo for a deep dive into how modern tools (IVUS, intravascular lithotripsy, advanced classification systems, and hybrid-OR workflow) are reshaping the way we evaluate and treat common femoral artery disease.Using real-world experience and early data from investigative studies, the conversation covers:• When to intervene on common femoral disease• CTA vs duplex for pre-op planning• How hybrid ORs change strategy and bailout options• Key differences between acute limb ischemia vs chronic CLTI femoral exposure• Why wound complications and groin integrity matter• Which patients surgeons worry about most• The rise of IVUS for sizing and anatomical confirmation• How IVL (M5+, L6) is changing luminal gain and safety• Why common femoral arteries are far larger than traditionally assumed• Challenges: lack of large-bore DCBs, bifurcation disease, proximal spillover• What future device platforms are still missing• Early trial design lessons comparing IVL + DCB vs endarterectomyA must-watch for anyone treating inflow disease, CLTI, or evaluating whether femoral interventions can be safely expanded beyond surgery alone.Chapters:00:00 – Introduction and setting the stage 01:00 – Why common femoral disease is a “sacred surgical zone” 02:00 – Indications for treating common femoral artery lesions 03:00 – Imaging workup: ultrasound vs CT 04:00 – When hybrid ORs become essential 05:00 – Acute limb vs chronic femoral disease: what changes surgically 06:30 – Groin complications and what surgeons fear most 08:00 – Patient types that raise surgical risk 09:00 – The durability of endarterectomy vs risks in fragile patients 10:00 – Why endovascular solutions matter for modern PAD demographics 11:00 – The biggest danger of early endovascular CFA therapy: dissection 12:00 – What technologies surgeons want when considering endovascular CFA work 13:00 – Calcification patterns and why IVL changed the game 14:00 – IVUS for femoral sizing: why CFA vessels are bigger than we thought 15:00 – Limitations: maximum DCB sizes and when they fall short 16:00 – L6 vs M5+: how the devices differ and when to use each 17:00 – European data on CFA stenting and bifurcation techniques 18:00 – Trial design: how to avoid bias when comparing endo vs open 19:00 – Classification systems (Ozema, Rapolino) and choosing appropriate patients 20:00 – Early lessons from IVL + DCB vs surgery investigation 21:00 – Future technologies needed for CFA therapy 22:00 – Closing thoughts: hybrid strategies and patient selection🔔 Subscribe for more insights from interventional experts and real-world program builders.📱 Download the app: https://apps.apple.com/app/apple-store/id1586692687📺 Follow us on YouTube: https://www.youtube.com/channel/UCfrLYhAhliQ2ZvXinkDCZvA#PeripheralArteryDisease #CommonFemoralArtery #IVL #IVUS #VascularSurgery #Endovascular #CLTI #PAD #HybridOR #MurmurMD #L6 #M5Plus #DCB #CalciumModification