Percutaneous transluminal atherectomy: preliminary results

Directional atherectomy and balloon angioplasty for lower extremity arterial disease

This study was undertaken to evaluate the use of directional atherectomy, balloon angioplasty, and video angioscopy in highly selected patients with superficial and popliteal artery stenoses. Directional atherectomy and balloon angioplasty for superficial femoral and popliteal artery stenosis (> 80%) were performed in 96 limbs (88 patients) between 1990 and 1994. All procedures were performed by the authors with angioscopy and C-arm angiography. Society for Vascular Surgery/International Society for Cardiovascular Surgery (SVS/ISCVS) categorical classification of chronic limb ischemia and run off scoring was utilized pre- and postoperatively to assess outcome. The indicators for atherectomy were moderate claudication (category 2, 15% of limbs), severe claudication (category 3, 65%), ischemic rest pain (category 4, 12%), and tissue loss (category 5, 12%). Morbidity was 6.0% with no perioperative mortality. All technically and (angiographically) successfully treated patients demonstrated postoperative improvement. Clinical assessment, vascular laboratory studies (outcome criteria), and/or angiography were monitored at follow-up visits. Intraoperative failures occurred in 6% of limbs due to inability to pass a guide wire (3%), impacted atherectomy catheter (1%), or vessel perforation (2%). In the remaining 90 limbs, 23% failed due to either progression of disease (7.7%) or restenosis at the original site (15.3%). Seventy-one percent of limbs maintained their postoperative categorical improvement at a mean follow up of 24 months. Combining atherectomy and balloon angioplasty may be more durable than angioplasty or atherectomy alone. A long-term prospective study of the role of directional atherectomy and balloon angioplasty by vascular surgeons appears to be warranted utilizing SVS/ISCVS guidelines for lower extremity chronic ischemia categories, run-off score, and outcome criteria for patency.

Infrainguinal directional atherectomy: long-term follow-up and comparison with percutaneous transluminal angioplasty

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.