|
Back to 2016 Annual Symposium ePosters
Midterm Outcomes of Rotational Atherectomy in Lower Extremity Arterial Disease
Kenneth R. Kollmeyer, M.D.1, James E. Harrell, M.D.2, Jasmine L. Richmond, M.S.1, Travis J. Miller, M.D.3, Robert W. Feldtman, M.D.1, Pablo V. Uceda, M.D.1, Samuel S. Ahn, M.D.1.
1DFW Vascualr Group, Dallas, TX, USA, 2Covenant Medical Center, Lubbock, TX, USA, 3Stanford Hospital and Clinics, Stanford, TX, USA.
OBJECTIVES:
Rotational atherectomy with the Rotablator® (Boston Scientific) device has been used in the treatment of complex coronary artery disease for many years, especially in heavily calcified coronary arteries. The purpose of this paper is to evaluate the safety and efficacy of rotational atherectomy (RA) in the treatment of severe femoral-popliteal arterial occlusive disease.
METHODS:
Rotational atherectomy was performed on 99 limbs in 97 cases with severe femoral-popliteal arterial disease, in 2013 and 2014 using the Rotablator ® device. A total of 137 arteries were treated with RA and the follow up duration was up to 24 months. Critical limb ischemia was present in 67%, severe claudication in 27% and moderate claudication in 6 % of cases. The average age was 71.6 years and the patient population was composed of 63 males (65%) and 34 females (35%). Target lesions included the superficial femoral artery (n= 80, 58 %), popliteal artery (n=48, 35%), and profunda femoral artery (n=9, 7%). The average length of lesions was 10.0 cm. 39% of arteries had occlusions and the average pre-op stenosis was 87%. 58 % of cases had RA performed in other arteries in the same limb, 85% of which were infrapopliteal arteries. Balloon angioplasty was used in 88% of treated arteries, tissue plasminogen activator was used in 50% of treated arteries, and self-expanding nitinol stents were used in 60%.
RESULTS:
Angiographic success of at least 20% reduction in stenosis was 100% in treated arteries. The average decrease in percent stenosis was 74.6% ± 22.1%. Procedural success was 99.3%. Primary patency and freedom from target lesion revascularization were 82% and 84 % respectively at 12 months. Clinical success, as shown by hemodynamic measurements below the target lesion, was seen in 76.8% of ABI measurements. Clinical improvement occurred in 78% of patients according to the Rutherford scale. Major amputation-free survival was 98% up to 24 months. Major complications (30 days) were seen in 3 patients (3%).Device success was 99%.
CONCLUSIONS:
Rotational atherectomy in severe femoral-popliteal arterial disease is safe and effective in the midterm combined with other treatment modalities, and was less costly than other atherectomy devices. Further studies are warranted to determine long term effectiveness and cost benefit.
Back to 2016 Annual Symposium ePosters
|
