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Effectiveness of Atherectomy and Drug-Coated Balloon Angioplasty in Femoropopliteal Disease: A Comprehensive Outcome

Hyeon Ju Kim1, Deokbi Hwang2, Woo-Sung Yun2

  • 1Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Chilgok Hospital, Daegu, Korea.

Vascular Specialist International
|October 3, 2024
PubMed

Insights

Atherectomy with drug-coated balloons (DCBs) is less effective for femoropopliteal occlusive disease (FPOD) in women, patients with severe calcification, and those on dialysis. Careful monitoring or alternative treatments like surgical bypass are recommended for these high-risk groups.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Peripheral Artery Disease

Background:

  • Atherectomy is used with drug-coated balloons (DCBs) to treat calcified atheroma in femoropopliteal occlusive disease (FPOD).
  • The efficacy of atherectomy and DCB angioplasty in severe calcification and associated outcomes requires further evaluation.

Purpose of the Study:

  • To assess the outcomes of atherectomy combined with DCB angioplasty for treating FPOD.
  • To identify risk factors associated with poor outcomes in patients undergoing this procedure.

Main Methods:

  • A retrospective study of 85 limbs in 76 patients with FPOD treated with atherectomy and DCB angioplasty from 2014 to 2022.
  • Primary patency (PP) and clinically driven target lesion revascularization (CD-TLR)-free survival were evaluated.
  • Lesion calcification was graded using the Peripheral Arterial Calcium Scoring System, with Grade 4 considered severe.

Main Results:

  • The 1-year PP and CD-TLR-free survival rates were 77% and 93%, respectively; 2-year rates were 64% and 83%.
  • Female sex, dialysis, and severe calcification were independent risk factors for poor PP.
  • Dialysis and severe calcification were identified as independent risk factors for CD-TLR.

Conclusions:

  • Atherectomy with DCB angioplasty demonstrated suboptimal outcomes in female patients, those with severe calcification, and patients undergoing dialysis.
  • Close patient monitoring is essential to detect patency loss and the need for revascularization in these subgroups.
  • Surgical bypass or conservative management may be more appropriate for specific patient groups requiring revascularization.
Abstract

Keywords:
AtherectomyDrug-coated balloonPeripheral arterial diseaseRevascularizationVascular patency

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