Effectiveness and Safety of Atherectomy versus Plain Balloon Angioplasty for Limb Salvage in Tibioperoneal Arterial Disease

Sharma, Payal; Ortiz, Daniel; Jan, M. Fuad; Khitha, Jayant; Allaqaband, Suhail; Bajwa, Tanvir; Mewissen, Mark W.; Nfor, Tonga

doi:10.1016/j.jvir.2022.11.021

Cited by 3 publications

(2 citation statements)

References 30 publications

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“…Third, they included both femoropopliteal and tibial arteries. Outcomes for below‐the‐knee interventions are generally worse than for femoropopliteal interventions 19 . A study by Mukherjee et al comparing atherectomy use in hospital outpatient and office‐based settings reported similar major amputation rates (2.3%–3.2%) to those reported in our study for atherectomy performed for femoropopliteal interventions 20 …”

Section: Discussionsupporting

confidence: 72%

Effects of atherectomy on major adverse limb events for femoropopliteal interventions: Vascular Quality Initiative registry

Effoe,

Mewissen,

Bajwa

et al. 2023

Cathet Cardio Intervent

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BackgroundAtherectomy use in treatment of femoropopliteal disease has significantly increased despite scant evidence of benefit to long‐term clinical outcomes.AimsWe investigated the clinical benefits of atherectomy over standard treatment for femoropopliteal interventions.MethodsUsing data from the Society of Vascular Surgery's Vascular Quality Initiative (VQI) registry, we identified patients who underwent isolated femoropopliteal interventions for occlusive disease. We compared 13,423 patients treated with atherectomy with 47,371 receiving standard treatment; both groups were allowed definitive treatment with a drug‐coated balloon or stenting. The primary endpoint was major adverse limb events (MALEs), which is a composite of target vessel re‐occlusion, ipsilateral major amputation, and target vessel revascularization.ResultsMean age was 69 ± 11 years, and patients were followed for a median of 30 months. Overall rates of complications were slightly higher in the atherectomy group than the standard treatment group (6.2% vs. 5.9%, p < 0.0001). In multivariable analysis, after adjusting for demographic and clinical covariates, atherectomy use was associated with a 13% reduction in risk of MALEs (adjusted odds ratio [aOR]: 0.87; 95% confidence interval [CI]: 0.77–0.98). Rates of major and minor amputations were significantly lower in the atherectomy group (3.2% vs. 4.6% and 3.3% vs. 4.3%, respectively, both p < 0.001), primarily driven by a significantly decreased risk of major amputations (aOR 0.69; 95% CI: 0.52–0.91). There were no differences in 30‐day mortality, primary patency, and target vessel revascularization between the atherectomy and standard treatment groups.ConclusionsIn adults undergoing femoropopliteal interventions, the use of atherectomy was associated with a reduction in MALEs compared with standard treatment.

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Section: Discussionsupporting

confidence: 72%

Effects of atherectomy on major adverse limb events for femoropopliteal interventions: Vascular Quality Initiative registry

Effoe,

Mewissen,

Bajwa

et al. 2023

Cathet Cardio Intervent

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“…Long-segmental occlusion of FP lesions is still a challenging problem for PAD therapy, in which BMS plays a major role. AT technology using different plaque removal systems is more conducive to obtaining the lumen and reducing the incidence of flow-limiting dissection, but the effectiveness of the application of AT alone is still controversial 14 , 27 , 28 , and some studies have proven that the clinical outcome of AT combined with the DCB procedure is better 11 , 12 . However, there is still a lack of head-to-head comparisons of BMS, DCB alone, AT + DCB, and AT alone procedures to determine the best therapy modality for FP lesions.…”

Section: Discussionmentioning

confidence: 99%

Comparison of mid-outcome among bare metal stent, atherectomy with or without drug-coated balloon angioplasty for femoropopliteal arterial occlusion

Yang,

Quan,

Dong

et al. 2024

Sci Rep

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This study evaluated the outcomes of a bare metal stent (BMS), DCB alone, atherectomy plus a drug-coated balloon (AT + DCB) and AT alone for the treatment of femoropopliteal artery occlusion. Four groups were included in this retrospective cohort study: 119 patients underwent the BMS procedure, 89 patients underwent DCB alone, 52 patients underwent AT + DCB, and 61 patients underwent AT alone. Patients were followed-up at 1, 6, 12 and 24 months after the procedure, the clinical outcomes and complications were assessed, and the primary outcomes were primary patency and restenosis. AT + DCB showed a lower bailout stent, and BMS displayed a higher retrograde puncture, flow-limiting dissection and postdilation (p < 0.05). For all procedures, the walking distance, ABI and pain score post-procedure were significantly improved compared with the pre-procedure values (p < 0.001). The restenosis rate was higher in BMS (21.0%) and AT alone (24.6%) than in DCB (10.1%) alone and AT + DCB (11.5%) (p = 0.04); there was no difference in amputation or clinically driven target lesion revascularization among procedures. The primary patency rates were 77.7%, 89.4%, 88.0% and 73.7% in the BMS, DCB alone, AT + DCB and AT alone groups at 24 months, respectively (p = 0.03), while the secondary patency and main adverse events (stroke, MI and death) were similar. Proximal concavity, proximal target vessel diameter ≥ 5 mm, runoff number ≥ 2 and DCB use were protective factors for primary patency. Our results suggested that AT + DCB and DCB alone were associated with higher primary patency, and DCB devices (combined with/without AT) should be the preferred choice for FP lesions.

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The Midterm Outcomes of Endovascular Therapy for Femoropopliteal Lesions via Drug-Coated Balloon, Directional Atherectomy and Bare Metal Stent Angioplasty

Lin,

Quan,

Dong

et al. 2024

Rev. Cardiovasc. Med.

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Background: This study investigated the midterm primary patency of drug-coated balloons (DCBs), directional atherectomy plus balloon angioplasty (DA), and bare metal stent (BMS) angioplasty for the treatment of femoropopliteal lesions. Methods: This two-center retrospective cohort study included 105 patients (110 limbs) undergoing DCB, DA, and BMS angioplasty—32 patients (34 limbs), 31 patients (32 limbs), and 42 patients (44 limbs), respectively. The demographic, baseline, and procedure data were collected, and the complications and midterm outcomes (patency, amputation-free survival, and clinically driven target lesion revascularization rates) were analyzed. Results: All three procedures achieved a 100% success rate. Significant improvements were noted in ankle brachial index, walking distance, and Rutherford classification at 30 days post-procedure (p < 0.001), with no differences or severe complications among the groups. The all-cause mortality rate during the follow-up period, was 5.5%, and amputation-free survival rates at 24 months were 97.0%, 90.6% and 90.9% in the DCB, DA, and BMS angioplasty groups, respectively. The primary patency rate for the DCB group (79.4%) exceeded those of the DA (56.2%) and BMS (52.2%) groups (p < 0.05), with no significant difference between the DA and BMS groups at 24 months. The secondary patency and clinically driven target lesion revascularization rates were similar among the three groups. A runoff number ≤1, Trans-Atlantic Intersociety Consensus (TASC) D, and severe calcification were found to be independent risk factors for primary patency. Conclusions: The DCB procedure demonstrated superior primary patency, compared to both BMS and DA procedures, in the treatment of femoropopliteal lesions.

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Effectiveness and Safety of Atherectomy versus Plain Balloon Angioplasty for Limb Salvage in Tibioperoneal Arterial Disease

Cited by 3 publications

References 30 publications

Effects of atherectomy on major adverse limb events for femoropopliteal interventions: Vascular Quality Initiative registry

Effects of atherectomy on major adverse limb events for femoropopliteal interventions: Vascular Quality Initiative registry

Comparison of mid-outcome among bare metal stent, atherectomy with or without drug-coated balloon angioplasty for femoropopliteal arterial occlusion

The Midterm Outcomes of Endovascular Therapy for Femoropopliteal Lesions via Drug-Coated Balloon, Directional Atherectomy and Bare Metal Stent Angioplasty

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