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[Debulking strategy of endovascular treatment for lower extremity artery lesions]

X L Jiang1, S Ju2, B Chen1

  • 1Department of Vascular Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China.

Zhonghua Wai Ke Za Zhi [Chinese Journal of Surgery]
|November 28, 2021
PubMed

Insights

Debulking therapy effectively treats lower extremity artery lesions, improving blood flow and limb salvage. Selecting appropriate methods like percutaneous mechanical thrombectomy or excimer laser ablation enhances outcomes.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Endovascular Therapy

Background:

  • Lower extremity artery lesions pose significant risks, including amputation and mortality.
  • Effective revascularization strategies are crucial for managing these complex conditions.
  • Debulking techniques offer a method to clear arterial obstructions.

Purpose of the Study:

  • To evaluate the feasibility and effectiveness of debulking strategies for lower extremity artery lesions.
  • To analyze the outcomes of different debulking methods based on lesion characteristics and location.

Main Methods:

  • Retrospective analysis of 101 patients who underwent debulking therapy for 140 lower extremity artery lesions.
  • Lesions were located in the iliac, superficial femoral, popliteal, tibiofibular trunk, and below-knee arteries.
  • Percutaneous mechanical thrombectomy (PMT), excimer laser ablation (ELA), and directional atherectomy (DA) were employed based on lesion type (acute thrombosis, chronic restenosis, calcified lesions).

Main Results:

  • PMT treated 58.6% of lesions, ELA treated 40.0%, and DA treated 1.4%.
  • Ankle-brachial index significantly improved post-procedure and was maintained at 12 months.
  • At 12 months, primary patency was 86.1%, freedom from major amputation was 93.1%, and mortality was 5.0%.

Conclusions:

  • Debulking therapy is a feasible and effective approach for eliminating arterial contents and restoring lumen.
  • Tailoring debulking methods to specific lesion characteristics and anatomical locations is key to achieving successful technical outcomes.
  • This strategy contributes to improved limb salvage and reduced reintervention rates in patients with lower extremity artery disease.

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