Atherectomy-Associated Complications in the Southern California Vascular Outcomes Improvement Collaborative

Azar, Yara; DeRubertis, Brian G.; Baril, Donald T.; Woo, Karen

doi:10.1016/j.avsg.2017.11.029

Cited by 13 publications

(8 citation statements)

References 9 publications

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“…Another retrospective study with 2048 peripheral vascular interventions (PVI) procedures was performed to determine the practice patterns of atherectomy for PVI in the Southern California Vascular Outcomes Improvement Collaborative (So Cal VOICe). 37 The rate of perforation was 2% in the atherectomy group and 2% in the no atherectomy group. Although the perforation rates in our meta-analysis showed an increasing trend in the atherectomy plus DCB group, the difference was not statistically significant compared with DCB only group (1.75% vs. 0.34%, RR: 2.04, 95%CI: 0.43-9.71, P ¼ 0.37).…”

Section: Discussionmentioning

confidence: 90%

Atherectomy plus drug-coated balloon versus drug-coated balloon only for treatment of femoropopliteal artery lesions: A systematic review and meta-analysis

et al. 2021

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Objectives To compare the safety and efficiency of atherectomy plus drug-coated balloon with drug-coated balloon only for the treatment of femoropopliteal artery lesions. Methods This systematic review and meta-analysis was performed and reported following the requirement of the PRISMA. EMBASE, MEDLINE, and Cochrane library were queried from January 2000 to June 2020 to identify eligible literature. The modified Downs and Black checklist was used to assess the quality of included studies. Outcome measures included bail-out stenting, distal embolization, perforation, hematoma, primary patency at 12 months, target lesion revascularization at 12 months, leg amputation at 12 months, and mortality at 12 months. We used DerSimonian and Laird random-effects model to pool the dichotomous data on risk ratio (RR) with 95% confidence intervals (CIs) from each study to obtain an overall estimate for major outcomes. Subgroup analysis and sensitivity analyses were conducted. Results Six studies (two randomized controlled trials and four retrospective cohort studies) with 470 patients were included. Atherectomy plus drug-coated balloon group was associated with lower rates of bail-out stenting (RR: 0.49, 95%CI: 0.34–0.71, P < 0.001). There was no significant difference between two groups in terms of distal embolization (RR: 2.06, 95%CI: 0.51–8.38, P = 0.31), perforation (RR: 2.04, 95%CI: 0.43–9.71, P = 0.37), hematoma (RR: 1.75, 95%CI: 0.43–7.09, P = 0.43), primary patency at 12 months (1.09, 95%CI: 0.98–1.21, P = 0.12), target lesion revascularization at 12 months (RR: 0.68, 95%CI: 0.41–1.14, P = 0.15), leg amputations at 12 months (RR: 0.54, 95%CI: 0.13–2.23, P = 0.39), mortality at 12 months (RR: 2.18, 95%CI: 0.71–6.64, P = 0.17). Sensitivity analysis had no effect on our findings. Conclusions The combination of atherectomy and drug-coated balloon was safe and effective in the treatment of femoropopliteal artery lesions, with lower incidence of bail-out stenting compared with drug-coated balloon only.

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Section: Discussionmentioning

confidence: 90%

Atherectomy plus drug-coated balloon versus drug-coated balloon only for treatment of femoropopliteal artery lesions: A systematic review and meta-analysis

et al. 2021

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“…In a multicenter study, 1-cm increase in lesion length brought two percent increased risk of atherectomy associated complications, and atherectomy was found to be related with increased risk of dissection. 23 In RESILIENT trial, stents were needed in 40.3% of the balloon angioplasty group, and it was found that longer lesions needed stent implantations. 1 Taking into consideration that the mean length of the current study was longer than the above-mentioned studies, it is not surprising to observe these rates of FLD and stent need.…”

Section: Discussionmentioning

confidence: 99%

Rotational atherectomy with adjunctive balloon angioplasty in calcified chronic total occlusions of superficial femoral artery

Engin¹,

Saydam²

2020

Vascular

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Objectives The aim was to report the mid-term outcomes of Jetstream™ rotational atherectomy device in complex femoropopliteal lesions. Methods Between November 2016 and April 2018, 55 patients who were treated with rotational atherectomy and adjunctive balloon angioplasty due to complex femoropopliteal lesions were retrospectively scanned. Results Fifty-five patients who underwent endovascular treatment with rotational atherectomy for chronic total occlusive femoropopliteal lesions were included in the study. Technical success rate was 100%. The mean age was 63 (±10.5) years. The cohort included 25 (45.4%) diabetics and 45 (81.8%) current smokers. The mean length of the lesions was 20.8 ± 11.2 cm. Chronic total occlusive lesions were detected in 35 (63.6%) patients, and mixed-type steno-occlusive lesions were detected in 20 patients (36.4%). Thirty-three (60%) lesions were moderate or severely calcified. Adjunctive balloon angioplasty was performed with plain old balloon angioplasty (POBA) on 31 (56.4%) patients and with drug-coated balloon angioplasty on 24 (43.6%) patients. After adjunctive balloon angioplasty, flow limiting dissection was observed in 20 (36.3%) patients, and 17 (30.9%) patients needed stent implantation. The Kaplan–Meier analysis method estimated that the overall primary patency rates at 12 and 24 months were 81.8% and 70.9%, respectively. Overall, secondary patency rates at 12 and 24 months were 94.5% and 80%. No statistically significant differences of 24-month primary patency and secondary patency rates were found between patients treated with drug-coated balloon angioplasty and POBA as an adjunctive therapy, even though primary patency (83.3% vs. 61.3%, p = .06) and secondary patency (91.7% vs. 71%, p = .56) rates of drug-coated balloon angioplasty were slightly higher than POBA. Patients with claudication had better primary patency (90.5% vs. 58.8%, p = .001) and secondary patency (100% vs. 67.6%, p = .004) rates than patients with critical limb ischemia at 24 months. Significant differences between patients who did and did not stop smoking were found in 24-month primary patency (57% vs. 88%, p = .007) and secondary patency (67% vs. 96%, p = .007). Six patients underwent unplanned amputation. There were eight (14.5%) mortalities during follow-up. Conclusions Rotational atherectomy with adjunctive balloon angioplasty has satisfactory technical success rates and mid-term outcomes. As an adjunctive method, there was no difference between drug-coated balloon angioplasty s and POBAs. Smoking cessation is always the first-step treatment to improve mid-term patency results. Patients with critical limb ischemia have worse patency results compared to the patients with claudication.

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“…죽종제거술과 관련된 합병증 발생은 병변의 길이가 길어질수록 유의미하게 증가한다고 보고되고 있으며( 37 ) 그 종류는 혈관 박리, 파열, 가성동맥류 형성, 원위 색전 등 기존의 PTA와 대동소이하다.…”

Section: 죽종제거술의 합병증과 한계unclassified

Atherectomy in Peripheral Artery Disease: Current and Future

권

김

원

et al. 2021

J Korean Soc Radiol

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죽종절제술은 당뇨병과 만성콩팥병증 등에 의해 발생하는 말초동맥질환에서 유망한 치료법이다. 죽종절제술은 기계적 방법을 통해 죽종 조직을 제거하여 혈관의 내경을 확대하는 것을 말한다. 방법의 특성상 주로 경피적 미세 침습 접근 방식에 국한하여 통용되는 용어이며, 현재 한국에서 사용 가능한 죽종절제술 장치는 두 가지가 있다. 죽종절제술이 성행하면서 “혈관 준비”라는 개념과 “아무것도 남기지 않기”라는 새로운 치료 개념이 대두되었다. 다양한 연구들이 죽종제거술의 안전성과 효용성을 증명하고 있지만 그 한계도 존재하므로, 환자 선택에 신중을 기할 필요가 있고 후속적인 대규모의 연구가 필요하다.

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Atherectomy-Associated Complications in the Southern California Vascular Outcomes Improvement Collaborative

Abstract: Increased treatment length is associated with an increased risk of atherectomy-associated complications. Demographic factors and comorbidities were not predictors of complications.

Cited by 13 publications

References 9 publications

Atherectomy plus drug-coated balloon versus drug-coated balloon only for treatment of femoropopliteal artery lesions: A systematic review and meta-analysis

Atherectomy plus drug-coated balloon versus drug-coated balloon only for treatment of femoropopliteal artery lesions: A systematic review and meta-analysis

Rotational atherectomy with adjunctive balloon angioplasty in calcified chronic total occlusions of superficial femoral artery

Atherectomy in Peripheral Artery Disease: Current and Future

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