Author + information
- Payal Sharma1,
- Tonga Nfor2,
- Daniel Ortiz2,
- M. Fuad Jan2,
- Jayant Khitha2,
- Suhail Q. Allaqaband2,
- Tanvir Bajwa2 and
- Mark W. Mewissen3
- 1Department of Internal Medicine, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin, United States
- 2Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin, United States
- 3Aurora St. Luke’s Vascular Center, Aurora St. Luke’s Medical Center, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin, United States
The use of atherectomy devices for the treatment of lower extremity arterial disease has been increasing despite sparse evidence of clinical benefit. The primary goal of intervention on occlusive arterial disease of tibial and peroneal arteries (TPA) is to prevent limb loss. We sought to compare rates of ipsilateral limb amputation, long-term vessel patency, and angiographic outcomes after endovascular intervention using atherectomy and balloon angioplasty on TPA for critical limb ischemia.
Using the multicenter PVI Registry™ we identified all patients with isolated endovascular intervention on TPA for occlusive disease Rutherford category 4 to 6 using atherectomy as first treatment device or balloon angioplasty. The 2 treatment groups were matched 1:1 by clinical and angiographic characteristics.
There were 1454 patients, with 2183 arteries treated, in the atherectomy group, and 1454 patients, with 2141 arteries treated, in the angioplasty group. Median follow-up time was 507 days. Mean age was 69 years ± 11.7 and the mean occluded length was 6.9 mm ± 6.5. The amputation rate was lower in the atherectomy group than the angioplasty group, 6.2% vs. 8.3%, p = 0.013, odds ratio 0.73 (95% confidence interval 0.57 to 0.94). This difference was driven by minor amputations. Procedural technical success was higher with atherectomy than angioplasty balloon 96.8% vs. 95%, p = 0.004. Vessel patency at 6 months was similar between atherectomy and balloon angioplasty, 66 vs. 63.5%, p = 0.35. There was no significant difference in the rates of vessel dissection, perforation, or distal embolization during the procedure. As shown in the table, contrast use and fluoroscopy time were significantly higher in the atherectomy group.
|Atherectomy||Balloon angioplasty||p value|
|Ipsilateral limb amputation Major amputation Minor amputation 6-month patency||6.2% 4.5% 3% 66%||8.3% 4.6% 4.1% 63.5%||0.01 0.86 0.08|
|Technical success Distal embolization Arterial perforation Arterial dissection Stent use Contrast volume in mL, mean ±SD Fluoroscopy time, mean ± SD||92.9% 1.2% 1.3% 2.3% 4.5% 103.6 ± 65.7 24.9 ± 16.9||91% 1.1% 0.6% 2.5% 6.3% 86.7 ± 58.3 20.3 ± 15.4||0.07 0.73 0.06 0.67 0.01 <0.001 <0.001|
In patients with critical limb ischemia from occlusive TPA disease, the use of atherectomy was associated with a decrease in the rate of incident amputation.
ENDOVASCULAR: Peripheral Vascular Disease and Intervention