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Percutaneous removal of atheromatous plaques in peripheral arteries
B Höfling1, A V Pölnitz, D Backa
1Department of Medicine, Klinikum Grosshadern, Ludwig-Maximilians-Universität, Munich, Federal Republic of Germany.
Insights
Peripheral Simpson atherectomy significantly improved leg circulation in 21 patients with stenotic lesions. Walking distance and Doppler index improved, with results sustained for six months.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Peripheral Artery Disease
Background:
- Peripheral artery disease (PAD) significantly impacts patient mobility and quality of life.
- Atherectomy is a key intervention for treating stenotic lesions in peripheral arteries.
- Evaluating the efficacy of atherectomy devices is crucial for optimizing PAD treatment.
Purpose of the Study:
- To assess the effectiveness of the Simpson atherectomy catheter in treating peripheral arterial stenotic lesions.
- To evaluate the impact of atherectomy on patient functional status and objective vascular measures.
- To determine the durability of atherectomy outcomes over a six-month follow-up period.
Main Methods:
- Retrospective analysis of 21 patients undergoing atherectomy for 41 peripheral stenotic lesions.
- Inclusion of iliac, superficial femoral, and popliteal artery lesions, including occluded and calcified cases.
- Assessment of outcomes using angiography, walking distance, Doppler index, stress tests, and scintigraphy.
Main Results:
- Significant reduction in mean stenosis from 82.7% to 21% (p<0.0001).
- Substantial improvements in standardized walking distance (79.9m to 152.6m, p<0.0001) and Doppler index (0.58 to 0.81, p<0.0001).
- Sustained improvements at six months with minimal restenosis, successfully managed by repeat procedures.
Conclusions:
- The Simpson atherectomy catheter is effective in treating complex peripheral arterial stenotic lesions.
- Atherectomy leads to significant and durable improvements in patient walking capacity and vascular function.
- Percutaneous atherectomy offers a viable option for managing peripheral artery disease with good long-term results.
Abstract:
The peripheral Simpson "atherectomy" catheter was used to treat 21 patients with a total of 41 stenotic lesions (5 iliac, 35 superficial femoral, and 1 popliteal). 4 lesions were totally occluded and 16 (39%) were calcified. The mean (SD) degree of obstruction was reduced from 82.7 (14) to 21 (16)% (p less than 0.0001). Mean (SD) standardised walking distance increased from 79.9 (71.9) to 152.6 (89.7) m (p less than 0.0001); doppler index improved from 0.58 (SD 0.17) to 0.81 (0.16) (p less than 0.0001); performance on bicycle stress test rose from 276.3 (range 1-1100) to 584.8 (2-2250) watt-min; and index for 201Tl-scintigraphy of the lower leg increased from 0.68 (0.28) to 0.91 (0.36) (p less than 0.02). The improvement has been maintained for 6 months, the degree of stenosis on repeat angiography at 2-6 months (n = 14 lesions) being 20.7 (SD 13.7)% (unchanged from early post-treatment values). The only restenosis has been corrected by a repeat of the percutaneous procedure.