Long-term results after directional atherectomy of femoro-popliteal lesions.
OBJECTIVE
Our objective in this research was the evaluation of the long-term results after directional atherectomy using the Silverhawk device (FoxHollow Technologies, Redwood City, California) of femoro-popliteal lesions.


BACKGROUND
Considering reports on stent fractures in femoro-popliteal arteries, atherectomy may be a valuable alternative to stenting.


METHODS
Eighty-four patients with 100 legs and 131 lesions with peripheral occlusive disease Rutherford categories 2 to 5 were included in a prospective registry. Forty-five lesions were de novo lesions (group 1; 34%), 43 lesions native vessel restenoses (group 2; 33%), and 43 lesions in-stent restenoses (group 3; 33%). Additional low pressure balloon angioplasty was used in 78 of 131 lesions (59%) and stenting in 8 lesions (6%).


RESULTS
Technical success rate was 86% for atherectomy only and 100% after additional therapy. Mean lesion length was 43 +/- 54 mm, 105 +/- 122 mm, and 131 +/- 111 mm for group 1, group 2, and group 3, respectively (p < 0.001). Primary patency, defined as freedom of a >50% restenosis detected by duplex, was 84%, 54%, and 54% at 12 months (p = 0.002) and 73%, 42%, and 49%, at 18 months (p = 0.008); secondary patency rates were 100%, 93%, and 91% at 12 months (p = NS) and 89%, 67%, and 79% at 18 months (p = 0.001), respectively; and target lesion revascularization rate was 16%, 44%, and 47% at 12 months and 22%, 56%, and 49% at 18 months (p = 0.003 each) for group 1, group 2, and group 3, respectively. The only independent predictor for restenosis was treatment of restenotic lesions. Ankle-brachial index was significantly improved after 12 months and 18 months in all groups.


CONCLUSIONS
Long-term technical and clinical results after directional atherectomy of femoro-popliteal lesions are in favor of de novo lesions compared with restenotic lesions.
Zeller
Thomas
T
Department of Angiology, Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany. thomas.zeller@herzzentrum.de
Rastan
Aljoscha
A
Sixt
Sebastian
S
Schwarzwälder
Uwe
U
Schwarz
Thomas
T
Frank
Ulrich
U
Bürgelin
Karlheinz
K
Müller
Christian
C
Rothenpieler
Uwe
U
Flügel
Peter-Christian
PC
Tepe
Gunnar
G
Neumann
Franz-Josef
FJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D001157:Arterial Occlusive Diseases / Q000628:therapy*; D017073:Atherectomy / Q000009:adverse effects; D015331:Cohort Studies; D004617:Embolism / Q000209:etiology / Q000628:therapy; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery; D011446:Prospective Studies; D012008:Recurrence; D016019:Survival Analysis; D016896:Treatment Outcome; D014654:Vascular Patency