Abstract No. 414 Peripheral atherectomy in Trans-Atlantic Inter-society Consensus (TASC) type C and D femoropopiliteal lesions in chronic limb ischemia

Abstract

To evaluate the efficacy of peripheral atherectomy device in TASC type C and D femoropopiliteal lesions. In a period of 14 months (December 2015 to January 2017), all patients with complaints of chronic limb ischemia were evaluated. A detailed clinical and laboratory evaluation, doppler scan with lower limb CT angiography was performed, to determine TASC lesion type for femoropopiliteal lesions. Patients falling in TASC C and D category were included in the study. Written informed consent was obtained. All the 11 patients were males and mean age was 56 years. 2 or more of risk factors (hypertension, diabetes, smoking and hyperlipidemia) were present in all patients. Clinically, all patients fell in Rutherford IV to VI category (category III-1, IV-2, V-1, VII-7). 2 patients had ABI beyond 1.2, suggestive of heavily calcified vessels. Femoral access was taken and occlusion was crossed using hydrophilic 0.035” guide-wire (Terumo) in 8 patients and using 0.014” wire (Nitrex, Medtronic) in 3 patients. The 0.035” wire was exchanged with 0.014” wire and Directional Atherectomy device (Turbohawk, Medtronic) was then used. A distal embolic protection device was not used. Post-atherectomy angiogram was taken, followed by DCB angioplasty (Medtronic). Co-existing tibial disease noted in 9 patients and co-existing iliac disease was treated. Technical success was considered if residual stenosis was less than 30%. Patients were evaluated on follow-up at 1, 3 and 6 months for symptomatic relief, limb salvage and for ABI. Postprocedure, increase in ABI was noted in the 9 patients with ABI between 0.2 to 0.8. In the 5 patients presenting with digital gangrene, level of amputation was confined to digits and thus preventing further progression of gangrene. Satisfactory wound healing was noted in all the 7 patients in Rutherford category VI. 1 patient with rest-pain had persistence of symptoms, despite persistently improved ABI and no residual stenosis on follow-up angiogram. Combination of atherectomy device with DCB, provides significant limb salvage results for TASC C and D femoropopilteal lesions.