Retrospective Review of Directional Atherectomy and Drug-Coated Balloon Use in a PAD Safety-Net Population
Shea E Hogan, Matthew Holland, Joseph Burke
1University of Colorado School of Medicine, Aurora, CO 80045 USA. pamela.peterson@cuanschutz.edu.
Insights
Directional atherectomy (DA) and drug-coated balloon (DCB) effectively treated peripheral artery disease (PAD) in a safety-net hospital. This combination therapy showed low complication rates and good outcomes for critical limb-threatening ischemia (CLTI) patients.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Public Health
Background:
- Peripheral artery disease (PAD) carries significant morbidity and mortality, especially critical limb-threatening ischemia (CLTI).
- Minority and vulnerable populations with CLTI often face worse outcomes.
- The use of directional atherectomy (DA) and drug-coated balloon (DCB) in safety-net populations for lower-extremity revascularization (LER) is understudied.
Purpose of the Study:
- To evaluate the demographic and clinical characteristics of patients with PAD treated with DA and DCB at a safety-net hospital.
- To assess the short- to intermediate-term outcomes of this treatment approach in a vulnerable patient group.
- To determine the efficacy and safety of combining DA and DCB for LER in a safety-net setting.
Main Methods:
- Retrospective, observational cohort study.
- Chart review of patients undergoing DA and DCB for PAD during LER from April 2016 to January 2020.
- Analysis of demographic data, clinical presentation, procedural outcomes, and complications.
Main Results:
- The study included 58 patients, with diverse demographics including 24% Black/African American and 31% Hispanic.
- Most patients (65%) presented with CLTI and had prior LER (58%).
- The DA and DCB combination showed efficacy with low bail-out stenting (16%) and target-vessel revascularization (26%) at 2 years, alongside low complication rates (e.g., tibial embolism 12%). Wound healing was achieved in 67% of Rutherford category 5 patients by 2 years.
Conclusions:
- In a safety-net population, patients frequently presented with CLTI and prior LER.
- The combination of DA and DCB demonstrated low complication rates and favorable short- to intermediate-term outcomes.
- This approach offers a viable solution for this frequently undertreated population with PAD.
Background:
Peripheral artery disease (PAD) is associated with high morbidity and mortality, particularly once patients develop critical limb threatening ischemia (CLTI). Minorities and vulnerable populations often present with CLTI and experience worse outcomes. The use of directional atherectomy (DA) and drug-coated balloon (DCB) during lower-extremity revascularization (LER) has not been previously described in a safety-net population.
Objective:
To review demographic and clinical characteristics, and short- intermediate term outcomes of patients presenting to a safety-net hospital with PAD treated with DA and DCB during LER.
Methods:
In this retrospective, observational cohort study, chart review was performed of all patients who underwent DA and DCB during LER for PAD from April 2016 to January 2020 in a safety-net hospital.
Results:
The analysis included 58 patients, with 41% female, 24% Black/African American, and 31% Hispanic. From this group, 17% spoke a non-English primary language and 10% reported current or previous housing insecurity. Most (65%) presented with CLTI and had undergone a previous index leg LER (58%). The combination of DA and DCB was efficacious, resulting in low rates of bail-out stenting (16%) and target-vessel revascularization (26%) at 2 years. Low complication rates (tibial embolism in 12% and vessel perforation in 2% of cases) were also observed. Most patients (67%) with Rutherford category 5 experienced wound healing by 2 years.
Conclusion:
In this safety-net population, the majority presented with CLTI and a previous LER of the index leg. The combination of DA and DCB resulted in low complication rates, and good short-intermediate outcomes in this frequently undertreated population.
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