Abstract
Purpose
Evaluate retrospectively the long-term primary patency of directional atherectomy (DA) in the femoropopliteal arteries.
Materials and Methods
DA was used alone in 59 patients (47%) or in combination with predilatation to allow passage of the device (43%) or after thrombolysis (10%) to treat 127 (93%) excentric atherosclerotic stenoses and nine (7%) occlusions of the femoropopliteal arteries. Forty-eight patients were followed by telephone interview, scheduled outpatient visits, color-flow Doppler evaluation, and angiography for 1–36 months (mean 16.9 months).
Results
Technical success (reduction of the stenosis or occlusion to less than 30% luminal diameter) was achieved in 110 lesions (80.3%) during 48 procedures in 37 patients. Mean luminal diameter was increased 54% with a concomitant increase in mean ankle/brachial indices of 0.33. According to Kaplan-Meier survival curves, patency at 12 and 24 months was 88% and 75%, respectively. When patients who retained patency but developed restenosis were excluded, the probability of patency at 12, 24, and 36 months was 76%, 58%, and 32%, respectively. Major and minor complications occurred in 15 (21.4%) procedures each for a total complication rate of 42.8%.
Conclusion
Based on our results, DA is an effective method for percutaneous treatment of atherosclerotic disease involving the femoropopliteal arteries. It has similar patency but a relatively high complication rate compared with PTA.
Similar content being viewed by others
References
Valdoni P, Venturini A (1964) Considerations on late results of vascular prostheses for reconstructive surgery in congenital and acquired arterial disease. J Cardiovasc Surg 5:509–520
Johnston KW (1992) Femoral and popliteal arteries: Reanalysis of results of balloon angioplasty. Radiology 183:767–771
van Breda A, Graor RA, Katzen BT, Rislus B, Gillings D (1991) Relative cost-effectiveness of urokinase versus streptokinase in the treatment of peripheral vascular disease. JVIR 2:77–87
Nardstrom LA, Castaneda-Zuniga WR, Von Seggern KB (1991) Peripheral arterial obstructions: Analysis of patency 1 year after laser-assisted transluminal angioplasty. Radiology 181:515–520
Kim D, Gianturco LE, Porter DH, Orron DE, Kuntz RE, Kent KC, Siegel JB, Sclam BW, Skillman JJ (1992) Peripheral directional atherectomy: 4-year experience. Radiology 183:773–778
Becker GJ, Katzen BT, Dake MD (1989) Noncoronary angioplasty. Radiology 170:921–940
Faxon DP, Weber VJ, Haudenschild C, Gottsman SB, McGovern WA, Ryan TJ (1982) Acute effects of transluminal angioplasty in three experimental models of atherosclerosis. Atherosclerosis 2:125–133
DiSegni R, Zollikofer CL, Casteneda-Zuniga W, Amplatz K (1991) Angioplasty: General principles and mechanisms. In: Kadir S (ed) Current practice of interventional radiology. B. C. Decker, Philadelphia, pp 51–57
Newman GE, Miner DG, Sussman SK, Phillips HR, Mikat EM, McCann RL (1988) Peripheral artery atherectomy: Description of technique and report of initial results. Radiology 169:677–680
Graor RA, Whitlow DL (1990) Transluminal atherectomy for occlusive peripheral vascular disease. J Am Coll Cardiol 15(7):1551–1558
Simpson JB, Selmon MR, Robertson GC, Cipriano PR, Hayden WG, Johnson DE, Fogarty TJ (1988) Transluminal atherectomy for occlusive peripheral vascular disease. Am J Cardiol 61:96G-101G
Schwarten DE, Katzen BT, Simpson JB, Cutliff WB (1988) Simpson catheter for percutaneous transluminal removal of atheroma. AJR 150:799–801
von Pölnitz A, Nerlich A, Berger H, Höfling B (1990) Percutaneous peripheral atherectomy: Angiographic and clinical followup of 60 patients. J Am Coll Cardiol 15:682–688
Becker GJ, Katzen BT, Dake MD (1989) Noncoronary angioplasty. Radiology 170:921–940
Johnston KW, Rae M, Hogg-Johnston SA, Colapinto RF, Walker PM, Baird RJ, Sniderman KW, Kalman P (1987) Five-year reults of a prospective study of percutaneous transluminal angioplasty. Ann Surg 206:403–413
Mulry CC, LeVeen RF, Sobel M, Lampe PJ, Burke DR (1991) Assessment of heparin anticoagulation during peripheral angiography. JVIR 2:133–139
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Savader, S.J., Venbrux, A.C., Mitchell, S.E. et al. Percutaneous transluminal atherectomy of the superficial femoral and popliteal arteries: Long-term results in 48 patients. Cardiovasc Intervent Radiol 17, 312–318 (1994). https://doi.org/10.1007/BF00203949
Issue Date:
DOI: https://doi.org/10.1007/BF00203949