Percutaneous transluminal rotational atherectomy in the treatment of peripheral vascular disease using a transluminal endatherectomy catheter (TEC): initial results and angiographic follow-Up.
OBJECTIVE
To evaluate the clinical results of percutaneous transluminal rotational atherectomy in the treatment of peripheral vascular disease.


METHODS
Rotational atherectomy was performed in 39 patients aged 39-87 years (mean 66.6 years). A total of 71 lesions (43 stenoses and 28 occlusions) were treated in 40 limbs. Additional balloon angioplasty was required in 54% of lesions. Fifteen patients (37.5%) presented in Fontaine stage II, 10 patients (25%) in Fontaine stage III and 15 patients (37.5%) in Fontaine stage IV. Rotational atherectomy at 750 rpm was carried out over a 0.014-inch guidewire with continuous aspiration into a vacuum bottle. Follow-up angiography and color flow Doppler examinations were performed in 22 patients (23 limbs) after a mean period of 6 months (range 2-14 months).


RESULTS
There was one primary technical failure. In 36 of 40 lesions there was a good angiographic result with residual stenoses in less than 30%. In 70 lesions treated by rotational atherectomy, however, 54% showed residual stenoses of 30%-50% and these cases required additional balloon angioplasty. The mean ankle-brachial index improved significantly (p << 0.001) from 0.49 before the procedure to 1.01 after the procedure. A single distal embolus, related to primary recanalization, occurred and there were two large inguinal hematomas. Cumulative clinical patency after 6 months was 83.8% and cumulative angiographic patency after 6 months was 79.1%.


CONCLUSIONS
Percutaneous rotational atherectomy is a promising approach for the treatment of chronic peripheral vascular disease. Further prospective, randomized studies are necessary to compare percutaneous transluminal angioplasty with this new technical approach.
Rilinger
N
N
Department of X-ray Diagnostics, Radiological University Clinic and Outpatient Clinic, University of Ulm, Steinhövelstrasse 9, D-89075 Ulm, Germany.
Görich
J
J
Scharrer-Pamler
R
R
Vogel
J
J
Tomczak
R
R
Merkle
E
E
Sokiranski
R
R
Brambs
H J
HJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D017073:Atherectomy / Q000295:instrumentation; D005500:Follow-Up Studies; D006801:Humans; D007866:Leg / Q000098:blood supply; D008875:Middle Aged; D016896:Treatment Outcome; D014654:Vascular Patency