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Journal of Vascular Surgery Apr 2024We evaluated the midterm results of atherectomy-assisted angioplasty for the treatment of femoropopliteal lesions and the identification of possible subgroups of...
OBJECTIVE
We evaluated the midterm results of atherectomy-assisted angioplasty for the treatment of femoropopliteal lesions and the identification of possible subgroups of patients with superior outcomes.
METHODS
We conducted a single-center, physician-initiated, nonindustry-sponsored retrospective analysis of patients with Rutherford category ranging from II to V and de novo occlusive or stenotic lesions of the superficial femoral (SFA) and/or popliteal arteries treated with atherectomy-assisted angioplasty (Jetstream rotational atherectomy + drug-eluting ballooning). In cases of subintimal recanalization or patients without an SFA stamp, with previous ipsilateral bypass surgery, systemic coagulopathy, end-stage renal disease requiring hemodialysis, life expectancy of <12 months, and intolerance to aspirin, clopidogrel, and/or heparin were excluded.
RESULTS
In a total of 103 enrolled patients, the median SFA and/or popliteal lesion length was 80 mm (interquartile range, 61.2 mm) with 73 lesions being occlusive (70.9%) and 84 (81.5%) classified as Fanelli calcification score 3 and 4. Technical success was met in 96.1% of cases (n = 99) at a median operative time of 108 minutes. Adjunctive stenting was needed in 10 patients (9.8%). At a median follow-up of 18.0 ± 10.8 months, Rutherford class clinical improvement was present in 77 patients (74.8%), and 7 patients (6.79%) presented target lesion occlusion needing reintervention in 6 cases (5.82%). The primary patency rates were 97% at 12 months and 83% at 24 months with secondary patency rates of 99% at 12 months and 91% at 24 months of follow-up. There were no significant differences when treating differently located lesions, diabetic vs nondiabetic patients, or comparing experienced vs nonexperienced operators.
CONCLUSIONS
The use of rotational atherectomy and drug-eluting balloons for the treatment of severe femoropopliteal disease showed relatively low need for bailout stenting and good midterm primary patency rates. The influence of lesion location, diabetes mellitus, or operator experience did not show statistically different results in terms of patency. Longer term outcomes and comparative analysis are needed to consolidate further clinical evidence.
Topics: Humans; Femoral Artery; Atherectomy, Coronary; Retrospective Studies; Treatment Outcome; Angioplasty, Balloon; Peripheral Arterial Disease; Popliteal Artery; Atherectomy; Vascular Patency
PubMed: 38128846
DOI: 10.1016/j.jvs.2023.12.030 -
Journal of Vascular Surgery Sep 2022Small, older studies have suggested that the use of atherectomy devices has become common in peripheral vascular interventions (PVIs) despite the paucity of strong...
OBJECTIVE
Small, older studies have suggested that the use of atherectomy devices has become common in peripheral vascular interventions (PVIs) despite the paucity of strong clinical guidelines. We analyzed the 10-year trends in the use of atherectomy for PVIs across the United States and identified the main predictors of atherectomy use.
METHODS
Using the Vascular Quality Initiative registry, we identified all patients who had undergone endovascular PVIs for occlusive lower extremity arterial disease from 2010 to 2019. Procedures in which an atherectomy device had been used as the primary or secondary device were classified as the atherectomy group. We calculated the frequency of atherectomy use over time and across geographic regions. Using regression modeling, we identified the factors that were independently associated with atherectomy use.
RESULTS
A total of 205,377 PVIs had been performed for 152,693 unique patients. During the 10-year period, 16.6% of the PVI procedures had used atherectomy, increasing from 8.5% in 2010 to 19.7% in 2019 (P < .0001). Across 17 geographic regions, we found a significant difference in the prevalence of atherectomy use, ranging from 8.2% to 29%. The strongest predictor of atherectomy use was performance of PVI in an office setting (odds ratio [OR], 10.08; 95% confidence interval [CI], 9.17-11.09) or ambulatory center (OR, 4.0; 95% CI, 3.65-4.39) vs a hospital setting. The presence of severe (OR, 2.6; 95% CI, 2.4-2.85) or moderate (OR, 1.5; 95% CI, 1.4-1.69) lesion calcification was also predictive of atherectomy use. Other predictive factors included elective status, insurance provider, lesion length, prior PVI, claudication symptoms, and diabetes mellitus.
CONCLUSIONS
Atherectomy use in PVI significantly increased from 2010 to 2019. We found wide regional variability in the use of atherectomy that seemed to be driven more strongly by nonclinical factors.
Topics: Atherectomy; Databases, Factual; Humans; Peripheral Arterial Disease; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; United States
PubMed: 35367566
DOI: 10.1016/j.jvs.2022.03.864 -
The Journal of Cardiovascular Surgery Apr 2021This study aimed to investigate performance, effectiveness, and safety of excimer laser atherectomy for the treatment of complex lower limb artery disease in a... (Observational Study)
Observational Study
BACKGROUND
This study aimed to investigate performance, effectiveness, and safety of excimer laser atherectomy for the treatment of complex lower limb artery disease in a real-world setting.
METHODS
In our prospective, multicenter registry, consecutive patients with complex lower limb lesions underwent excimer laser atherectomy with optional standard balloon angioplasty, paclitaxel-coated balloon angioplasty, and bailout stenting. Primary outcome was technical success. Secondary outcomes were device performance of the excimer laser system, freedom from target lesion revascularization (TLR), peri-procedural complications, and amputation-free survival in patients with critical limb ischemia (CLI).
RESULTS
A total of 294 patients were enrolled at 14 European centers (mean lesion length 109±103 mm, total occlusions 56.8% [167 of 294 lesions], CLI 47.3% [132 of 279 patients]. Adjuvant balloon angioplasty was conducted in 283 (96.3%), and complementary stent implantation in 98 patients (33.3%). Technical success was achieved in 95.3% of patients. Increasing lesion length was associated with decreased laser atherectomy performance (odds ratio [OR] per 10 mm: 0.94 [95% confidence interval [CI] 0.90 to 0.99], P=0.01). A total of 66 patients (22.4%) completed the 12-month follow-up. Freedom from TLR was 83.5% (95% CI: 74.9 to 92.1) at 12 months. Chronic total occlusions were associated with more TLR (OR 5.03 [95% CI: 1.01 to 25.1], P=0.049). Amputation -free survival in patients with CLI was 93.1% (95% CI: 83.9 to 100).
CONCLUSIONS
Excimer laser atherectomy substantially contributed to technical success of endovascular treatment of complex infra-inguinal lesions. Freedom from 12-month TLR was reasonable.
Topics: Angiography; Angioplasty; Atherectomy; Europe; Female; Humans; Lasers, Excimer; Leg; Male; Peripheral Arterial Disease; Prospective Studies; Registries; Stents
PubMed: 33480520
DOI: 10.23736/S0021-9509.21.11569-1 -
Seminars in Vascular Surgery Mar 2008The superficial femoral artery (SFA) is the interventionalist's most frequent adversary in infrainguinal revascularization, and we have yet to conquer it. Despite having... (Review)
Review
The superficial femoral artery (SFA) is the interventionalist's most frequent adversary in infrainguinal revascularization, and we have yet to conquer it. Despite having numerous devices and techniques in our arsenal, we have, in large part, been unable to devise a treatment that yields not only excellent, safe, and reproducible acute outcomes, but also consistently good results at long-term follow-up. Angioplasty and stenting of the SFA has come under severe criticism due to numerous reports of stent fractures, unacceptable restenosis rates, and lack of US Food and Drug Administration-approved specific stents in this location. An alternative to displacement techniques is now being pursued. These include debulking the atheromatous plaque. We review these techniques and also offer helpful tips to achieve maximum success in infrainguinal revascularization.
Topics: Angioscopy; Atherectomy; Atherosclerosis; Equipment Design; Humans; Practice Guidelines as Topic; Treatment Outcome
PubMed: 18342735
DOI: 10.1053/j.semvascsurg.2007.11.002 -
Cardiovascular Intervention and... Apr 2022
Topics: Atherectomy; Atherectomy, Coronary; Coronary Artery Disease; Humans; Risk Factors; Severity of Illness Index; Treatment Outcome; Vascular Calcification
PubMed: 33666858
DOI: 10.1007/s12928-021-00768-5 -
Cardiovascular Revascularization... Nov 2020Balloon uncrossable lesions are common and can be challenging to treat. The most commonly used initial treatment strategies are using a small balloon (occasionally...
Balloon uncrossable lesions are common and can be challenging to treat. The most commonly used initial treatment strategies are using a small balloon (occasionally intentionally rupturing it) and increasing guide catheter support. Atherectomy can be challenging to perform in this setting, as the insertion of an atherectomy guidewire requires crossing the lesion with a microcatheter or over-the-wire balloon, which often fails. We report the use of the ViperWire Advance flex tip guidewire (Cardiovascular Systems, Inc., St. Paul, Minnesota) for primary wiring of a heavily calcified balloon uncrossable lesion, followed by orbital atherectomy and successful equipment crossing leading to procedural success.
Topics: Atherectomy; Humans; Minnesota; Treatment Outcome; Vascular Calcification
PubMed: 32067912
DOI: 10.1016/j.carrev.2020.02.001 -
Annals of Vascular Surgery Jul 2019As patient care is being increasingly transitioned out of the hospital and into the outpatient setting, there is a growing interest in developing office-based...
BACKGROUND
As patient care is being increasingly transitioned out of the hospital and into the outpatient setting, there is a growing interest in developing office-based angiography suites, that is, office-based laboratories. Office-based care has been associated with increased efficiency and greater patient satisfaction, with substantially higher reimbursement directly to the physicians providing care. Prior studies have demonstrated a shift of revascularization procedures to office-based laboratories with a concomitant increase in atherectomy use, a procedure with disproportionately high reimbursement in comparison to other peripheral revascularization techniques. We sought to determine provider trends in endovascular procedure volume, settings, and shifts in practice over time, specific to atherectomy.
METHODS
Using Centers for Medicare & Medicaid Services Provider Utilization and Payment Data Public Use Files from 2013 to 2015, we identified providers who performed diagnostic angiography (DA), percutaneous transluminal angioplasty (PTA), stent placement (stent), and atherectomy, and procedures were aggregated at the provider level. Trends in procedures performed in office-based laboratory and facility-based settings were analyzed. Atherectomy was specifically analyzed using the total number and proportion of office-based laboratory procedures, and providers were stratified into quintiles by case volume.
RESULTS
Between 2013 and 2015, 5,298 providers were identified. Over this time period, the number of providers performing atherectomy increased 25.7%, with the highest quintile of atherectomy providers performing an average of 263 cases (range 109-1,455). The proportion of physicians who performed atherectomy only in the office increased from 39.8% to 50.7% from 2013 to 2015, whereas only 20.8% of physicians who performed DA, PTA, or stent in 2015 did so only in an office-based laboratory. Of the physicians with the highest atherectomy volume, 77.8% operated only in the office in 2015, and these physicians increased their atherectomy volume to 114.1% during the study period. Of those physicians who transitioned to a solely office-based laboratory practice over the study period, atherectomy volume increased 63.4%, which was disproportionate compared with the growth of their DA, PTA, and stent volume.
CONCLUSIONS
Over this short study period, a rapid shift into the office setting for peripheral intervention occurred, with a concomitant increase in atherectomy volume that was disproportionate to the increase in other peripheral interventions. This increase in office-based laboratory atherectomy occurred in the setting of increased reimbursement for the procedure and despite a lack of data supporting superiority over PTA/stent.
Topics: Aged; Ambulatory Care Facilities; Ambulatory Surgical Procedures; Angiography; Angioplasty; Atherectomy; Centers for Medicare and Medicaid Services, U.S.; Fee-for-Service Plans; Female; Humans; Male; Office Visits; Practice Patterns, Physicians'; Stents; Time Factors; United States
PubMed: 30684609
DOI: 10.1016/j.avsg.2018.12.059 -
The Journal of Cardiovascular Nursing Oct 1992Coronary atherectomy, a new invasive procedure for the treatment of atherosclerotic heart disease, consists of the excision and removal of atherosclerotic tissue from... (Review)
Review
Coronary atherectomy, a new invasive procedure for the treatment of atherosclerotic heart disease, consists of the excision and removal of atherosclerotic tissue from coronary artery walls. This article provides current information on atherectomy, including its potential advantages over percutaneous transluminal coronary angioplasty (PTCA). Indications, limitations, medical research, and implications for nursing research are described. A case study is presented.
Topics: Atherectomy, Coronary; Humans; Male; Middle Aged
PubMed: 1447582
DOI: 10.1097/00005082-199210000-00005 -
Cardiovascular Intervention and... Apr 2022
Topics: Aneurysm, False; Arteries; Atherectomy; Atherectomy, Coronary; Humans; Iatrogenic Disease; Treatment Outcome
PubMed: 34117980
DOI: 10.1007/s12928-021-00781-8 -
Techniques in Vascular and... Dec 2005Peripheral vascular disease represents the largest obstructive subsegment within the vascular system. Advances in equipment, techniques, biochemical treatments, and the... (Review)
Review
Peripheral vascular disease represents the largest obstructive subsegment within the vascular system. Advances in equipment, techniques, biochemical treatments, and the influx of multiple specialties into this arena indicate a coming tidal wave of change to the standard treatment plan for patients with claudication and especially critical limb ischemia. Initial attempts in the 1980s to utilize the "laser" to treat peripheral vascular disease led to a clinical debacle: wavelengths and methods were not optimized; tissue heating was excessive, resulting in restenosis. Since then the "laser" has fallen from grace for endovascular treatment, although it has an infinite set of potential wavelengths, energy levels, and delivery methods. The xenon chloride, excimer laser, a pulsed 308-nm system, has overcome many of these early catastrophes. The long, ongoing success of this method of photoablating thrombus and plaque represents a true step forward in the endovascular treatment of occlusive disease. Although only a tool, the excimer laser provides a means to utilize electromagnetic energy instead of shearing mechanical force to resolve occlusions. With its active element at the tip, the excimer laser requires much less mechanical translation force to cross total occlusions, find the distal lumen, and thereby cause less plaque destabilization. In addition, removing the firm surface layer of plaque, decapping, and some of the plaque volume, debulking, exposes the softer subsegments of the plaque to balloon angioplasty. Utilizing this method, more complex lesions can be approached safely, with a high likelihood of successful revascularization and a low risk of potentially limb-threatening complication.
Topics: Angiography; Angioplasty, Laser; Atherectomy; Humans; Low-Level Light Therapy; Peripheral Vascular Diseases; Stents
PubMed: 16849094
DOI: 10.1053/j.tvir.2006.04.003