Society For Clinical Vascular Surgery

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Combined Directional Atherectomy and Drug Coated Balloon Angioplasty for Treatment of Femoropopliteal Stenotic Lesions: How well does it work? A Systematic Review of the Literature
Nektarios Charisis, M.D.1, Stefanos Giannopoulos, M.D.2, Apostolos Tassiopoulos, M.D.1, George J. Koullias, M.D., Ph.D.1.
1Stony Brook University Hospital, Stony Brook, NY, USA, 2251 HAF and VA Hospital, Athens, Greece, Athens, Greece.

OBJECTIVES: A current popular strategy of addressing femoral/popliteal occlusive disease, involves combining the debulking action of atherectomy with the potentially beneficial antirestenotic effects of Drug-Coated Balloon (DCB) angioplasty. This combined strategy, although popular, has not been extensively evaluated since published studies are few, and there is no systematic review of this approach. Therefore, in this study, we sought to evaluate the safety, efficacy and outcomes of the combined use of directional atherectomy (DirA) followed by DCB angioplasty in the treatment of femoropopliteal stenotic lesions.

METHODS: This systematic review was conducted according to the PRISMA guidelines and eligible studies were identified through search of the PubMed, Scopus and Cochrane Central databases. We used descriptive statistics with the help of STATA 13 to analyze our data.

RESULTS: Five studies comprising a total of 168 patients were included in this systematic review. Of these patients, 67.9% were men, 37.7% diabetic, 83% hypertensive, and 70.6% had dyslipidemia. Lesions were located in superficial femoral artery (SFA n=92 lesions), in distal SFA/popliteal artery (n= 23 lesions) and in the popliteal artery (n=58 lesions). Mean lesion length was 103.3mm, and from the lesions that were reported with the TASC system, the vast majority were TASC B and C. 40.5% of the lesions showed severe calcification based on angiographic, fluoroscopic and radiographic measurements. All patients underwent DirA followed by DCB angioplasty. Pre-intervention angiography demonstrated a mean diameter stenosis of 87.3%. Procedural success was 93.6%. Periprocedural complication rates, including bailout stenting and peripheral embolization, were very low. Primary patency at 6 months and 12 months was 80.8% and 72.9% respectively. Three out of five studies that were included in this systematic review were comparative. In these studies, this combined strategy was associated with better event-free survival at 12 months of follow up, higher primary patency rate and higher technical success respectively.

CONCLUSIONS: The combined use of DirA and DCB angioplasty for femoropopliteal stenotic lesions is safe and effective. DirA and DCB angioplasty is associated with high procedural success, low periprocedural complications, and very acceptable primary patency rates. Future studies with more patients are warranted to validate our results.


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