Transluminal atherectomy for occlusive peripheral vascular disease

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Peripheral Artery Disease

Background:

• Balloon angioplasty often yields suboptimal long-term results for superficial femoral artery (SFA) disease.
• Developing alternative catheter-based interventions is crucial for improving patient outcomes.

Purpose of the Study:

• To evaluate the efficacy and safety of percutaneous atherectomy for treating SFA stenosis or occlusion.
• To compare outcomes between simple (lesion length < 5 cm) and complex (lesion length > 5 cm) lesions.

Main Methods:

• 112 patients with SFA stenosis/occlusion underwent percutaneous atherectomy.
• Lesions were categorized as simple or complex based on length.
• Urokinase thrombolysis was used adjunctively in 16 patients.
• Success defined as < 20% residual stenosis on arteriography.

Main Results:

• Initial success rates were 100% for simple lesions and 93% for complex lesions.
• At 12-month follow-up, patency rates were 93% (simple) and 86% (complex).
• Restenosis specimens showed myointimal hyperplasia and organized thrombus.
• Major complications occurred in 7.1% of patients (3.5% simple, 8.3% complex), primarily hematomas.

Conclusions:

• Femoropopliteal atherectomy demonstrates high success rates and low morbidity/mortality.
• It is a viable alternative to balloon angioplasty for severe peripheral vascular disease.
• The procedure is effective for both simple and complex SFA lesions.