Author + information
- Apurva Patel1,
- Roosha Parikh1,
- Becky Naoulou1,
- Rahul Gokhroo1,
- Orkhan Guliyev2,
- Joseph Puma1 and
- Tak Kwan1
Technological advances have made endovascular approach the treatment of choice for the management of symptomatic peripheral arterial disease (PAD). However, the presence of severe calcification, particularly in the infrainguinal vasculature, presents a significant procedural challenge. Plaque modification strategies by debulking using an atherectomy device has been used to reduce restenosis rate compared to angioplasty and stenting alone. Successful treatment via traditional transfemoral approach may be limited due to complications including thromboembolism, slow flow, acute vascular closure and vascular complication. Using a retrograde transpedal approach (TPA) may reduce these complications.
We analyzed prospectively collected data on patients with symptomatic PAD who underwent endovascular intervention with atherectomy using TPA, from 7/2015 - 1/2017. Primary endpoint was 1 year major adverse events (MAE) - death, amputation and target lesion revascularization (TLR). Secondary endpoint was peri-intervention thromboembolism, slow flow, acute closure, access site patency and access complication at 30 days. Follow up was censored at 1st MAE event or at 1 year follow up.
A total of 743 patients (Age 75 years. Rutherford Class 3-5 100%) underwent endovascular intervention with atherectomy for 1254 lesions (Table). Procedural success rate was 99.4%. The 1 year MAE was 13.8%. There were no peri-intervention thromboembolism, slow flow or acute closure. At 30 days, access site pseudoaneurysm was 0.2%, AV fistula was 0.3% and access site occlusion was 0.08%.
|Peripheral Run-off (mean ± SD)||2.0 ± 0.9|
|Orbital Atherectomy + Balloon Angioplasty, %||85|
|Directional Atherectomy + Balloon Angioplasty, %||15|
|Distal Protection, %||0|
Treatment of infrainguinal calcified lesions using atherectomy via TPA is safe and feasible and may reduce TFA associated complications.
ENDOVASCULAR: Peripheral Vascular Disease and Intervention