Peripheral directional atherectomy: 4-year experience.

Abstract

Directional atherectomy alone or with supplemental percutaneous transluminal angioplasty was used to treat peripheral vascular lesions in 77 patients (85 procedures). Lesions involved 17 iliac arteries, 45 infrainguinal arteries, and 23 laser extremity vein bypass grafts. Technical success, defined as reduction of stenosis diameter to 30% or less of the normal vessel diameter, was achieved in 78 of 85 (92%) cases. The complication rate was 21% (18 of 85 procedures). Most complications were minor and were related to puncture sites. Patients underwent noninvasive follow-up studies, including measurement of ankle-brachial index and segmental pressures, plethysmography, and clinical examination. The mean follow-up period was 13.5 months. The probability of 1-, 2-, and 3-year patency for lesions treated with atherectomy alone was 92%, 84%, and 84%, respectively. Kaplan-Meier survival analysis revealed no difference in 2- to 3-year patency rate on the basis of lesion location or presence of calcification, eccentricity, or ulceration. Diabetic patients, however, had a higher restenosis rate than did patients who were not diabetic (P less than .03).

Evaluation of Directional Atherectomy Studied by Intravascular Ultrasound in Femoropopliteal Artery Stenosis

“…Therefore, new devices have been developed to create a smooth vessel wall less susceptible to superimposed thrombus and myointimal hyperplasia. Directional atherectomy (DA) is the most used alternative and the patency rates for short lesions are equal to or even better than those for PTA [18][19][20].…”

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

“…The mechanism of transluminal angioplasty consists of a focal fracture of the atheromatous plaque and associated stretching or minimal tearing of the intima with extension to the muscularis media of the arterial wall [15,16]. This resultant focal dissection, however, may lead to platelet aggregation, diminution of flow, thrombogenic activity, and ultimately acute closure [9]. In addition, these factors are also responsible for significant restenosis rates, which have been a plague for interventional radiologists since Dotter's first recanalization procedures in 1964 [17].…”

“…A substantial rate of restenosis after PTA, particularly for femoropopliteal recanalization [1][2][3], has led to the search for more effective percutaneous techniques [4][5][6]. One such technique, directional atherectomy (DA) with the Simpson peripheral atherectomy catheter, has been shown to have a high technical and initial clinical success rate [7][8][9]. This procedure was found to be effective in the treatment of iliac and infrainguinal lesions [7][8][9] as well as in venous bypass graft stenoses [9].…”

“…One such technique, directional atherectomy (DA) with the Simpson peripheral atherectomy catheter, has been shown to have a high technical and initial clinical success rate [7][8][9]. This procedure was found to be effective in the treatment of iliac and infrainguinal lesions [7][8][9] as well as in venous bypass graft stenoses [9]. A limited number of reports have also demonstrated acceptable long-term patency rates for DA [7,9], but improved long-term patency after DA compared with PTA has not been firmly established.…”

“…This procedure was found to be effective in the treatment of iliac and infrainguinal lesions [7][8][9] as well as in venous bypass graft stenoses [9]. A limited number of reports have also demonstrated acceptable long-term patency rates for DA [7,9], but improved long-term patency after DA compared with PTA has not been firmly established.…”