Back to 2016 Annual Symposium Abstacts

OBJECTIVES:
While angioplasty and stenting remain the mainstay of endovascular management of peripheral arterial disease, percutaneous atherectomy is a newer modality which provides additional treatment options. Distal embolization is a known complication of atherectomy and some clinicians advocate the prophylactic use of embolic protection devices (EPD); such devices can also be used for emboli retrieval on an as-needed basis. While EPD were originally designed for use with carotid stenting, where the risk of complications from distal embolization is significant, they have now gained popularity for use in lower-extremity interventions. The goal of this study is to determine if the routine use of prophylactic embolic protection devices (PEPD) is indicated.
METHODS:
Over a 44-month period ending August 31, 2014, 743 lower-extremity endovascular atherectomies were performed for claudication or chronic critical ischemia on 511 patients by a single group of surgeons in the southeast. A prospectively collected database was retrospectively analyzed for clinical outcomes including embolization, filter complications, limb-status, reintervention, and mortality within a 65-day period.
RESULTS:
PEPD were used in 146 endovascular atherectomies (20%). Embolization occurred despite PEPD use in 8 cases (5%). Macrodebris was noted in the PEPD 46% of the time. Atherectomy was performed without PEPD in 597 interventions and embolization occurred in 25 cases (4%); EPD were used to retrieve emboli in 14 of these cases and were successful in all instances (100%). Overall, intra-operative filter complications were present in one case with PEPD (1%) and no cases with EPD used for retrieval (0%). Sixty-five day follow up was available for 129 atherectomies with PEPD (88%) and 463 unprotected atherectomies (78%); reintervention rates were 4% and 8%, respectively (p=0.1152). At follow up, 98% of limbs were free of major amputation after protected atherectomy and 97% after unprotected atherectomy (p=0.8647).
CONCLUSIONS:
While PEPD use is advocated by some physicians during endovascular atherectomy, their benefit has not been proven over use for emboli retrieval. As these devices cost approximately \ each, an estimated \,000 would have been saved over the length of this study. Given the expense of distal protection devices, the risk of filter complications, and the high success rate of emboli retrieval after atherectomy without distal protection, this study suggests that endovascular atherectomy without distal embolic protection is not only safe but cost-effective.