Transluminal atherectomy for occlusive peripheral vascular disease

Abstract

The failure of balloon angioplasty to provide a durable result has lei to the development of other methods of catheter-associated interventional therapy. In this study, 112 patients with superficial femoral artery stenosis or occlusion were treated with percutaneous atherectomy. Patients were considered to have a simple lesion if the occluded or stenotic arterial segment was <5 cm, and a complex lesion if the length of the occluded segment was >5 cm. All atherectomies were performed in the superficial femoral and popliteal arteries; urokinase thrombolysis was used in conjunction with atherectomy in 16 patients, Atherectomy was considered successful if there was <20% residual stenosis determined by arteriography.Initial atherectomy results (30 day patency) were 100% successful in the group with a simple lesion and 93% successful in the group with a complex lesion. At a mean follow-up period of 12 months (range 5 to 24), there was a continued patency rate of 93% and 86%m, respectively, in the simple and complex groups. In the patients who had restenosis, all pathologic specimens obtained during the second procedure demonstrated myointimal hyperplasia and organized thrombus.Eight major complications (7.1%) occurred, including one fatal myocardial infarction. The complication rate was 3.5% in the simple group and 8.3% in the complex group. With the exception of the myocardial infarction, all complications were associated with catheter entry site hematomas.Femoropopliteal atherectomy has a high rate of success and low morbidity and mortality or both simple and complex lesions and is a viable and competitive alternative therapy for patients with severe peripheral vascular disease. Noninvasive follow-up with segmental pressure measurements and duplex ultrasound scanning is important to detect restenosis. The adjunctive use of urokinase to simplify the segment of atherectomy and remove offending thrombus appears to be useful and safe.