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OBJECTIVES: Atherectomy has been shown to effectively treat femoropopliteal disease, but very little has been reported on its usefulness in iliac artery disease. The objective of our study was to provide an initial evaluation of the safety and efficacy of orbital atherectomy in treating iliac artery lesions.
METHODS: This is a retrospective, multi-center study of patients treated with orbital atherectomy between 11/2009-7/2011. Peri-procedural data was collected on an intent-to-treat basis and included: patient and lesion characteristics, procedural characteristics, results, and complications.
RESULTS: 85 iliac artery lesions in 79 patients (58% male, mean age 70±2 years) were treated, with a median Rutherford stage of 3 (range 1-6). Most lesions were de-novo (96%) with a mean stenosis diameter of 86±2% [occluded: n=5 (6%)] and a mean length of 45±8mm (range 2-200mm). Plaque morphology included lesions that were >75% calcified: n=50 (60%); 50-75% calcified: n=29 (35%); 25-50% calcified: n=0 (0%); <25% calcified: n=1, (1%); fibrotic: n=4 (5%); and soft plaque: n=0 (0%). Orbital atherectomy achieved a mean stenosis reduction of 39±4% with stand-alone treatment. Angioplasty was performed in 73 patients (86%). The mean maximum inflation pressure was 6.4±0.7mmHg (range 1-12mmHg) and achieved a mean residual stenosis of 11±3%. Stents were placed in 37 (44%) patients. Embolic protection was not used in these procedures. The procedural success rate was 96%. There were no mortalities and the complication rate was 8%. Complications included acute thrombosis: n=1 (1%); embolism: n=1 (1%); dissection: n=4 (5%); and perforation: n=1 (1%).
CONCLUSIONS: Initial assessments show orbital atherectomy to be safe and effective in treating peripheral arterial disease of the iliac artery. Further studies are necessary to determine patency, limb salvage, and cost effectiveness of these procedures compared to other treatment modalities.