Print this pagePeripheral Atherectomy in TransAtlantic InterSociety Consensus Type C Lesions for Limb Salvage: Mid-term Results.
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Andrea E. Yancey, MD, David J. Minion, MD, Christian Rodriguez, MD, Donald E. Patterson, MD, Eric D. Endean, MD.
University of Kentucky Medical Center, Lexington, KY, USA.
BACKGROUND:
Peripheral atherectomy using the Foxhollow Silverhawk device has rapidly become a popular treatment option for infrainguinal occlusive disease. However, the majority of available data on this device is derived from the company’s own selective data registry. There is a paucity of peer-reviewed studies evaluating its efficacy, and these predominately involve claudicators. Previous studies in other lower extremity revascularization procedures have shown disparate results when the indication is limb salvage compared to claudication. The purpose of this study is to examine our experience with atherectomy for limb salvage.
METHODS:
A retrospective review of all patients undergoing infra-inguinal atherectomy for limb salvage at our institution was performed. Data was collected regarding TransAtlantic InterSociety Consensus (TASC) anatomic classification, indication for procedure, pre- and post-procedure ankle-brachial index, and clinical outcome. Analysis was performed using Student’s paired t-test and life-table analysis.
RESULTS:
Seventeen procedures were performed on 16 limbs in 15 patients. All patients had TASC-C lesions. Three procedures were performed for rest pain, the remainder for tissue loss. Follow-up ranged from 1-12 months. Four patients underwent a concurrent inflow procedure at the time of atherectomy. The technical success rate was 100%. The average ankle-brachial index improved from .38 ± .09 pre-operatively to .76 ± .09 immediately following intervention (p < 0.01). Initial complete healing of the ulcer or resolution of rest pain occurred in 8 patients (50%). However, 3 of these patients subsequently developed re-stenosis requiring re-intervention. Partial healing occurred in 5 others (31%), with 2 patients developing re-stenosis requiring re-intervention. Three limbs required below knee amputation (19%). Two were performed early for progressive necrosis felt to be secondary to severe pedal disease. The other occurred at 7 months secondary to hemodynamic failure despite re-intervention. Life table analysis revealed a re-stenosis rate of 57 ± 12% at 12 months.
CONCLUSIONS:
Atherectomy of infrainguinal occlusive disease for limb salvage is technically feasible and provides favorable immediate hemodynamic improvement. Limb salvage rates are acceptable. However, the re-stenosis rate is high, necessitating diligent follow-up and appropriate re-intervention.