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Percutaneous atherectomy of occlusive peripheral vascular disease: stenoses and/or occlusions
Insights
Percutaneous atherectomy effectively treated peripheral artery disease in 131 patients, achieving high success rates with minimal complications. This minimally invasive procedure showed a low lesion recurrence rate, offering a safe treatment option for claudication and critical limb ischemia.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Peripheral Artery Disease Treatment
Background:
- Peripheral artery disease (PAD) significantly impacts patient quality of life.
- Traditional treatments for PAD carry risks and limitations.
- Percutaneous atherectomy offers a less invasive approach to PAD management.
Purpose of the Study:
- To evaluate the safety and efficacy of percutaneous atherectomy using the Simpson Atherocath in patients with PAD.
- To assess the histopathological findings of atherectomy specimens.
- To determine the early recurrence rate of treated lesions.
Main Methods:
- A prospective study involving 131 patients undergoing percutaneous atherectomy with the Simpson Atherocath.
- Patients presented with claudication or critical limb ischemia.
- Successful procedure and complication rates were recorded, along with histopathological analysis and early angiographic follow-up.
Main Results:
- Successful atherectomy was achieved in 98% of stenoses and 100% of occluded vessels.
- No serious complications leading to limb loss or emergency surgery were reported.
- Histopathology revealed atheromatous plaque (66%), tunica media (45%), and thrombus (30%), with occluded vessels more likely to contain thrombus and tunica media.
- Early follow-up showed a low lesion recurrence rate of 17%.
Conclusions:
- Percutaneous atherectomy is a safe and effective treatment for stenotic and occluded peripheral arteries.
- The procedure demonstrates high technical success and a favorable safety profile.
- Low lesion recurrence rates suggest long-term benefits for patients with PAD.
Abstract:
Percutaneous atherectomy was performed using the Simpson Atherocath on 131 patients (87 male, 66%) with a mean age of 65 years. Clinical characteristics included evidence of significant coronary disease in 50%, hypertension in 46%, diabetes in 41%, and prior neurologic deficit in 32% of patients. The indication for atherectomy was claudication in 114 (87%) and rest pain, gangrene, or ulcer in 17 patients (13%). Atherectomy was successfully performed in 136/139 stenoses (98%) and in 56/56 occluded vessels with or without prior balloon angioplasty. No serious complications resulting in limb loss or emergency vascular surgery were encountered. Histopathology of retrieved specimens showed that 66% had atheromatous plaque, 45% had tunica media, and 30% had a form of thrombus. Material obtained from an occluded vessel was more likely to have thrombus and tunica media present than that from a stenosis (P less than 0.02 and P less than 0.05, respectively). Early angiographic follow-up (mean time, 17 weeks) showed a relatively low (17%) lesion recurrence rate. Percutaneous atherectomy can be successfully utilized in stenotic and occluded peripheral arteries with good success and no serious complications; stenoses appear to have a low recurrence rate.