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 endarterectomy

A 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

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