title: Determinants of patency after percutaneous angioplasty and atherectomy of occluded superficial femoral arteries.
abstract: BACKGROUND
  Patients undergoing percutaneous recanalization of chronically occluded superficial femoral arteries were studied to determine which factors correlated with 1-year patency. Immediate change in ankle:brachial index (ABI), length of occlusion, tibial run-off, and the performance of supplemental catheter atherectomy were evaluated.
  
  
  METHODS
  Eligible patients had at least one patient tibial run-off vessel and the absence of limb-threatening ischemia. Recanalization was performed via passage of a guidewire followed by balloon angioplasty. Tibial run-off was scored based on a modification of the angiogram scoring system of the Society for Vascular Surgery and the International Society for Cardiovascular Surgery. Supplemental transcutaneous extraction catheter atherectomy was randomly assigned to a sub-group of patients after initial experience with the recanalization technique. Clinical follow-up was employed to determine patency.
  
  
  RESULTS
  Forty-two of 57 attempts (74%) at recanalization were immediately successful. Overall 1-year patency was 40% in 40 limbs that could be followed. In limbs with balloon angioplasty alone (n = 23), patency was 43% compared with 35% in those having supplemental atherectomy. Tibial run-off did not vary significantly between patent and occluded groups. When ABI increased by 0.3 or more, patency was 56% compared with 26% when the ABI increase was less than or equal to 0.1 (P = 0.13). Occlusion length averaged 18.1 +/- 10.6 cm for all limbs and did not vary significantly between early successes and failures. Limbs with short occlusions (less than or equal to 5 cm, n = 8) had 63% patency compared with 38% patency for limbs with long occlusions (greater than 25 cm, n = 16), but the difference was not significant by analysis of variance.
  
  
  CONCLUSIONS
  An initial change in ABI was most predictive for patency, whereas no correlation with tibial run-off was demonstrated. Atherectomy did not increase patency. Short occlusions were more likely to remain patent than long ones, but overall patency was lower than described in other series.
authors.affiliation: Department of Surgery, University of California, Orange.
authors.forename: I L
authors.initials: IL
authors.lastname: Gordon
authors.forename: R M
authors.initials: RM
authors.lastname: Conroy
authors.forename: J M
authors.initials: JM
authors.lastname: Tobis
authors.forename: C
authors.initials: C
authors.lastname: Kohl
authors.forename: S E
authors.initials: SE
authors.lastname: Wilson
mesh_terms: D000704:Analysis of Variance; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D017073:Atherectomy / Q000379:methods; D002406:Catheterization, Peripheral; D002908:Chronic Disease; D003131:Combined Modality Therapy; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005500:Follow-Up Studies; D006801:Humans; D011182:Postoperative Care; D011859:Radiography; D012039:Regional Blood Flow / Q000502:physiology; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology