Acute procedural outcomes of orbital atherectomy for the treatment of iliac artery disease: Sub-analysis of the CONFIRM registries

Abstract

Endovascular intervention is an appealing revascularization strategy for iliac artery disease. Atherectomy of the iliac artery is uncommon due to the risk of life-threatening perforation but may be necessary if the iliac lesion is heavily calcified, preventing stent delivery or optimal expansion. We assessed the feasibility and safety of orbital atherectomy for the treatment of iliac artery disease. Demographic data, lesion characteristics, and procedure outcomes for the CONFIRM patients with at least one iliac artery lesion treated with orbital atherectomy (n=62 patients; n=68 lesions) were compared to patients with at least one superficial femoral artery (SFA) lesion treated with orbital atherectomy (n=1570 patients; n=1809 lesions). The procedural complication rate, defined as the composite of flow limiting dissection, perforation, slow flow, vessel closure, spasm, embolism, or thrombosis, was compared in iliac lesions versus SFA lesions. The iliac artery group had more patients with diabetes, shorter lesions, and more severely calcified lesions. The orbital atherectomy run time was significantly shorter in the iliac artery group. Additionally, in the iliac group there was one reported perforation and one reported vessel closure; the rates of slow flow, spasm, embolism, thrombus, and flow limiting dissection were 0%. The overall procedural complication rate was significantly lower in the iliac group (2.9% vs. 11.2%, p=0.03). Orbital atherectomy of the iliac artery is feasible with few reported angiographic complications and compared favorably with the SFA group. Orbital atherectomy may be considered to facilitate the delivery and expansion of a balloon or stent if the iliac artery is calcified.