Comparison of Long-Term Results According to Localization of Stenosis and Occlusion in Patients Undergoing Atherectomy for Infrainguinal Peripheral Arterial Disease

Abstract

Background

Endovascular treatment is an effective treatment option for peripheral arterial disease, which is a common disease with an increasing incidence rate. The importance of vessel preparation methods in endovascular treatment is well understood, and atherectomy, one of these methods, is frequently used to treat patients with peripheral arterial disease. In this study, we aimed to compare the primary patency rates and long-term outcomes of patients who underwent atherectomy for infrainguinal peripheral arterial disease according to lesion location.

Methods

In the Department of Cardiovascular Surgery at Tertiary Academic Center, 120 patients who underwent atherectomy due to infrainguinal peripheral arterial disease between January 2014 and December 2018 were retrospectively examined. Demographic data, claudication distance, Rutherford classification, ankle/brachial index (ABI), lesion length and localization were noted. The patients were divided into three groups on the basis of lesion location: superficial femoral artery (SFA), popliteal, or infrapopliteal. All patients underwent rotational atherectomy and subsequent balloon angioplasty. The ABI, Rutherford classification, and Doppler ultrasonography results were recorded at the 1-, 2- and 5-year follow-ups after the procedure.

Results

There were a total of 120 patients in the study. The mean age of the patients was 68.75 ± 7.44 years. Acute technical success was achieved in 115 (95.83%) of the 120 patients. The rates of patients with <50% noncritical stenosis based on Doppler ultrasonography control were 100.0% in the SFA group, 100.0% in the popliteal group, and 88.9% in the infrapopliteal group at the first year; 95.0%, 93.0%, and 80.6% at the second year; and 89.2%, 84.0%, and 75.0% at the fifth year, respectively. The rate of <50% noncritical stenosis in all patients was 96.5% at the first year, 89.6% at the second year, and 82.8% at the fifth year.

Conclusion

Vessel preparation methods should be considered in the endovascular treatment of infrainguinal peripheral arterial disease. We can conclude that the technical success rates of atherectomy and subsequent complementary drug-coated balloon angioplasty are high, and the restenosis rates and complication rates due to peripheral arterial disease are at an acceptable level with the preservation of lifestyle changes and the regular application of medical treatment after the procedure.