Single center experience with percutaneous peripheral atherectomy with the use of C-arm scopy for the treatment of lower extremity peripheral artery disease

Abstract

Objectives: This study aimed to present our results of endovascular procedures including balloon angioplasty combined with or without atherectomy for the treatment of iliofemoral and distal lesions with the use of a C-arm scopy. Patients and methods: The retrospective study was conducted on 153 patients (100 males, 53 females; mean age: 60.2±2.1 years; range, 53 to 82 years) with the diagnosis of peripheral artery disease between January 2017 and January 2020. The symptoms of the patients were claudication, rest pain, or tissue loss. The operations were performed at the operation theatre with local or spinal anesthesia in a supine or prone position according to the lesion status. Lesions were classified as superficial femoral, popliteal, and distal lesions below the knee. Results: Interventional treatment was applied in all patients, and 272 lesions in 204 extremities were intervened. In 78 patients, 160 right leg lesions were treated, and in 75 patients, a total of 112 lesions were treated. Fifty-one patients had bilateral leg lesions. The number of iliac, superficial femoral, and popliteal and distal segment lesions was 30 (11.1%), 213 (78.3%), and 29 (10.6%), respectively. Most of the lesions were confined to the SFA. We performed percutaneous transluminal angioplasty procedures in all 153 patients; however, 143 of them also received atherectomy with two different reliable devices (Avinger in 45 patients, Invamed in 114 patients). All interventions were done on a standard operating theatre bed with a C-arm scope. Doppler ultrasonography was used for popliteal imaging during the insertion. We did not encounter any problems in 125 patients. In 28 patients, progress was observed in the leg or ischemic wound between 30 and 65 postoperative days. A total of 23 patients required amputation; amputations were minor (finger amputation) in five patients and major (below the knee) in 18 patients. Conclusion: The perioperative and mid-term follow-up results of our study indicate that atherectomy and drug-coated balloon angioplasty may safely be performed by C-arm scopy with favorable outcomes.