Is infrainguinal percutaneous atherectomy better suited for certain arteries than others?
Stephen Kolakowski1, Keith D Calligaro, Matthew J Dougherty
1Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, Pennsylvania, USA.
Insights
Percutaneous rotational atherectomy is effective for infrapopliteal (IP) arteries, showing higher success and lower reintervention rates compared to femoropopliteal (FP) arteries and grafts.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Therapy
Background:
- Peripheral artery disease (PAD) affects both femoropopliteal (FP) and infrapopliteal (IP) arteries, necessitating effective treatment strategies.
- Percutaneous rotational atherectomy is a minimally invasive technique used to treat arterial stenoses and occlusions.
- Comparing outcomes of atherectomy in different arterial beds is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate the efficacy of percutaneous rotational atherectomy in treating infrapopliteal (IP) arteries versus femoropopliteal (FP) arteries and infrainguinal arterial autogenous vein grafts (GRAFTS).
- To determine if atherectomy is more successful in smaller diameter IP vessels compared to larger diameter FP vessels and GRAFTS.
Main Methods:
- A retrospective analysis of 32 patients undergoing atherectomy between January 2005 and December 2006 for symptoms of PAD.
- Vessels treated included FP arteries, IP arteries (superficial femoral, popliteal, tibial, peroneal), and failing GRAFTS.
- Outcomes were compared between combined FP + GRAFT lesions and IP lesions based on procedural success, need for adjunctive angioplasty, reintervention rates, and limb salvage.
Main Results:
- Procedural success rates were higher for IP lesions (83%) compared to FP + GRAFTS (70%).
- IP lesions showed a significantly lower rate of reintervention (0% vs. 25%) and a trend towards less need for adjunctive balloon angioplasty.
- Limb salvage rates were higher for IP lesions (100%) compared to FP + GRAFTS (90%) during the short follow-up period.
Conclusions:
- Percutaneous rotational atherectomy is a viable and effective treatment for short-segment infrapopliteal arterial stenoses and occlusions.
- Atherectomy in IP arteries demonstrates superior short-term outcomes, including lower reintervention and complication rates, compared to FP arteries and grafts.
- These findings support the use of atherectomy catheters for treating IP lesions in patients with peripheral artery disease.
Objective:
We analyzed our results with percutaneous rotational atherectomy catheters and specifically examined whether they were more likely to be associated with a successful outcome when used to treat smaller diameter vessels such as infrapopliteal (IP) arteries compared to larger diameter femoropopliteal (FP) arteries and infrainguinal arterial autogenous vein grafts (GRAFTS).
Material And Methods:
Between January 1, 2005, and December 31, 2006, athrectomies were performed on 32 patients for claudication (14), gangrene (9), rest pain (4), and failing GRAFTS (5). Treated vessels included 14 superficial femoral, 1 popliteal, 5 anterior tibial, 4 posterior tibial, and 3 peroneal arteries along with 5 failing GRAFTS. All procedures were performed by vascular surgeons in an endovascular operating suite using a mobile C-arm. Results for larger diameter vessels including FP arteries and GRAFTS were combined (FP + BYPASSES) and compared to results of IP artery lesions. Follow-up averaged 10 weeks (range, 0.5-34 weeks).
Results:
Length of treated lesions averaged 4.2 cm (range, 1-15 cm) for FP + GRAFT lesions (9 occlusions, 11 stenoses) versus 1.8 cm (1-4 cm) for IP lesions (6 occlusions, 6 stenoses; P = ns). Procedural success rate based on postoperative segmental pressures, pulse volume recordings, and duplex ultrasound was 70% (14/20) for FP + GRAFTS versus 83% (10/12) for IP lesions (P = .03). Need for concomitant adjunctive balloon angioplasty to treat residual stenosis tended to be higher for FP + GRAFT lesions (40% [8/20]) compared to IP lesions (25% [3/12]; P = ns). During follow-up, 25% (5/20) of FP + GRAFTS lesions required reintervention (3 balloon angioplasties, 1 thrombectomy, 1 GRAFT pseudoaneurysm) versus none for the IP lesions (P = .03). Limb salvage rates were 90% (18/20) for FP + GRAFT lesions versus 100% (12/12) for IP lesions during this short follow-up.
Conclusions:
These preliminary results suggest that short segment IP arterial stenoses and occlusions can be successfully treated with atherectomy catheters with a lower rate of reintervention during short-term follow-up, less need for concomitant adjunctive balloon angioplasty and a lower complication rate compared to FP + graft lesions.
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