Infrainguinal atherectomy using the transluminal endarterectomy catheter: patency rates and clinical success for 144 procedures.
OBJECTIVE
To determine if atherectomy using the transluminal endarterectomy catheter (TEC) is an effective endoluminal therapy for infrainguinal occlusive disease.


METHODS
Three surgeons used the TEC for 144 infrainguinal atherectomy procedures in 133 patients. The indications were severe claudication in 83, critical ischemia in 56, and graft stenosis in 5 limbs. The pathology was stenosis in 36 and occlusion in 105 limbs. Balloon dilation was also performed in 109 and stenting in 17 limbs.


RESULTS
There was initial technical and anatomic success in 124 (86%) procedures. There were 67 technically successful procedures at mean follow-up of 19 months, although 3 of these limbs with gangrene and extensive distal disease required major amputation. There were 26 failures due to stenosis leading to further intervention and 51 due to occlusion. Twenty of these cases were managed conservatively, 21 were treated with repeat endovascular intervention, 31 with bypass grafting, and 5 with amputation. Repeat intervention in 52 limbs resulted in 36 with patent arteries, 10 that are occluded, and 6 that required amputation. Thirteen of the 14 amputations were for limbs with critical ischemia, but 1 was in a patient with claudication. Life-table analysis showed that the primary patency rate was 51%, the assisted primary patency rate was 61%, and the secondary patency rate was 75% at 15 months. The clinical success rate was 49%, and the salvage rate for limbs with critical ischemia was 78% at 12 months. Univariate log-rank testing showing no significant differences according to the clinical presentation of pathology, but results were worse for lesions > 5 cm long due to more frequent immediate failures. However, multivariate Cox regression analysis showed that results were significantly worse for critical ischemia than for claudication, stenosis compared to occlusions, for limbs with poor runoff, for operations performed by percutaneous rather than an open approach, and for those performed more recently.


CONCLUSIONS
TEC atherectomy may have a place in selected patients, but the optimal circumstances for its use and long-term efficacy require further study.
Myers
K A
KA
Department of Vascular Surgery, Monash Medical Centre, Monash University Melbourne, Australia.
Denton
M J
MJ
Devine
T J
TJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000601:surgery; D017073:Atherectomy / Q000295:instrumentation* / Q000379:methods; D002404:Catheterization; D004691:Endarterectomy / Q000295:instrumentation; D005260:Female; D006801:Humans; D007264:Inguinal Canal / Q000098:blood supply*; D007511:Ischemia / Q000601:surgery; D007866:Leg / Q000098:blood supply; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000601:surgery*; D012044:Regression Analysis; D016896:Treatment Outcome; D014654:Vascular Patency