Peripheral atherectomy in TransAtlantic InterSociety Consensus type C femoropopliteal lesions for limb salvage
Andrea E Yancey1, David J Minion, Christian Rodriguez
1University of Kentucky Medical Center and the Veteran's Affairs Medical Center, Lexington, 40536, USA.
Insights
Peripheral atherectomy offers early symptom relief and improved hemodynamics for TransAtlantic Societal Consensus (TASC) type C femoropopliteal lesions. However, high mid-term restenosis rates necessitate further investigation for this critical limb ischemia patient group.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Therapy
Background:
- TransAtlantic Societal Consensus (TASC) type C femoropopliteal lesions present a significant challenge in infrainguinal occlusive disease management.
- Optimal therapeutic strategies for these complex lesions, particularly in patients with critical limb ischemia, remain under investigation.
- This study focuses on the outcomes of atherectomy using the FoxHollow SilverHawk catheter for TASC C femoropopliteal lesions.
Purpose of the Study:
- To evaluate the clinical and hemodynamic outcomes of treating TransAtlantic Societal Consensus (TASC) type C femoropopliteal lesions.
- To assess the effectiveness of the FoxHollow SilverHawk atherectomy catheter in patients with critical limb ischemia.
- To determine limb salvage rates and symptom resolution following endovascular intervention.
Main Methods:
- Retrospective review of 18 consecutive femoropopliteal atherectomy procedures in 17 limbs (16 patients) from September 2004 to September 2005.
- Data collected included demographics, angiographic findings, and procedural indications.
- Clinical outcomes (symptom resolution, limb salvage) and hemodynamic improvement (ankle-brachial index) were assessed; stenosis-free patency was determined using Kaplan-Meier analysis.
Main Results:
- The cohort (mean age 72.5 years) had significant comorbidities; indications were tissue loss (13 limbs) or rest pain (4 limbs).
- Initial symptom resolution occurred in 12 limbs, with 2 partial healing; 3 early amputations were likely due to severe distal disease.
- Ankle-brachial index improved post-procedure (0.39 to 0.75, P=.02) but declined to 0.48 at 6 months; 12-month stenosis-free patency was 22%.
Conclusions:
- Peripheral atherectomy demonstrates early clinical and hemodynamic success in patients with TASC C lesions and critical limb ischemia.
- However, the study highlights high mid-term restenosis rates in this challenging patient population.
- Further research is warranted to improve long-term outcomes for these complex femoropopliteal lesions.
Background:
The optimal therapy for TransAtlantic Societal Consensus (TASC) type C femoropopliteal lesions remains a critical issue in the treatment of infrainguinal occlusive disease. The purpose of this study was to evaluate the outcome of limbs with TASC C femoropopliteal lesions and critical limb ischemia treated with the FoxHollow SilverHawk atherectomy catheter.
Methods:
From September 2004 to September 2005, 18 consecutive femoropopliteal procedures performed in 17 limbs in 16 patients were reviewed. Demographic data, baseline angiographic findings, and indications for the procedures were recorded. Clinical outcomes including symptom resolution and limb salvage were determined for the 17 primary procedures. Hemodynamic improvement was compared by using the paired Student t test. Stenosis-free patency was determined by the Kaplan-Meier method.
Results:
The mean age was 72.5 years (range, 47-88 years). Fifty percent of the patients had four or more of the following risk factors: hypertension, diabetes, tobacco use, hyperlipidemia, renal insufficiency, and coronary artery disease. The indication was tissue loss in 13 limbs and rest pain in 4. All patients had a second level of disease, either inflow or tibial/pedal, which was treated concurrently when appropriate. Initial resolution of symptoms was achieved in 12 limbs, and partial healing was achieved in 2 others. Early amputation was necessary in the remaining three patients, but this was likely due to severe inframalleolar disease and advanced forefoot ischemia at the time of presentation. Five patients have remained symptom-free without restenosis at a mean follow-up of 6 months. Two patients have required late amputation for hemodynamic failure. The ankle-brachial index improved from 0.39 +/- 0.08 (mean +/- SEM) before surgery to 0.75 +/- 0.08 in the immediate postoperative period (P = .02). However, it returned toward baseline at 6 months after surgery, with a mean of 0.48 +/- 0.07. Stenosis-free patency of the femoropopliteal segment was 22% at 12 months.
Conclusions:
Peripheral atherectomy can achieve good early clinical and hemodynamic success in patients with TASC C lesions and critical limb ischemia. However, mid-term restenosis rates are high in this challenging cohort of patients.
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