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Infrainguinal directional atherectomy: long-term follow-up and comparison with percutaneous transluminal angioplasty
P M Wildenhain1, M H Wholey, C R Jarmolowski
1Department of Radiological Sciences and Diagnostic Imaging, Shadyside Hospital, Pittsburgh, PA 15232.
Insights
Directional atherectomy (DA) for femoropopliteal artery disease shows high technical success and improved long-term patency compared to balloon angioplasty (PTA). DA offers a viable treatment for infrainguinal stenoses.
Area of Science:
- Vascular surgery
- Interventional cardiology
- Peripheral artery disease
Background:
- Femoropopliteal artery atherosclerotic lesions are a common cause of peripheral artery disease.
- Percutaneous transluminal balloon angioplasty (PTA) is a standard treatment, but long-term results can be limited.
- Directional atherectomy (DA) offers an alternative approach for lesion treatment.
Purpose of the Study:
- To evaluate the long-term outcomes of directional atherectomy (DA) in treating femoropopliteal artery atherosclerotic lesions.
- To compare the efficacy of DA with previously reported results of percutaneous transluminal balloon angioplasty (PTA).
Main Methods:
- Retrospective review of 84 percutaneous DA procedures in 75 patients (July 1988 - August 1992).
- Assessment of technical and initial clinical success.
- Long-term patency evaluation using ankle-brachial index and angiography.
Main Results:
- High initial technical success rate of 92% (77/84 procedures).
- Mean follow-up of 17.4 months for 88% of procedures.
- Primary patency rates of 78% at 1 year and 57% at 2 years.
- Lower patency observed in patients with diabetes, complete occlusion, or limb salvage indications.
Conclusions:
- Directional atherectomy (DA) is a safe procedure for femoropopliteal artery lesions with high technical and initial success.
- DA demonstrates improved long-term patency compared to published PTA data.
- DA represents a valuable treatment option for focal infrainguinal stenoses.
Purpose:
To assess the long-term results of directional atherectomy (DA) for femoropopliteal artery atherosclerotic lesions and to compare the results to those previously reported for percutaneous transluminal balloon angioplasty (PTA).
Materials And Methods:
Eight-four percutaneous DA procedures performed on 75 patients between July 1988 and August 1992 were retrospectively reviewed and evaluated for technical and initial clinical success. Long-term patency was assessed with a combination of ankle-brachial index measurements and angiography.
Results:
Initial technical success was achieved in 77 of 84 procedures (92%). Follow-up of 72 patients was obtained, including 74 of the 84 (88%) DA procedures with a mean follow-up of 17.4 months (range 1-48 months). Primary patency was 78% at 1 year and 57% at 2 years. Patients with diabetes, complete luminal occlusion, or limb salvage situations had significantly lower patency.
Conclusions:
Femoropopliteal artery DA can be performed safely with a high technical and initial clinical success. Long-term patency is improved when compared with published series for PTA. With this improvement in mind, DA may have a place in the treatment of focal infrainguinal stenoses.