title: Long-term results after directional atherectomy of femoro-popliteal lesions.
abstract: 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.
authors.affiliation: Department of Angiology, Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany. thomas.zeller@herzzentrum.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Zeller
authors.forename: Aljoscha
authors.initials: A
authors.lastname: Rastan
authors.forename: Sebastian
authors.initials: S
authors.lastname: Sixt
authors.forename: Uwe
authors.initials: U
authors.lastname: Schwarzwälder
authors.forename: Thomas
authors.initials: T
authors.lastname: Schwarz
authors.forename: Ulrich
authors.initials: U
authors.lastname: Frank
authors.forename: Karlheinz
authors.initials: K
authors.lastname: Bürgelin
authors.forename: Christian
authors.initials: C
authors.lastname: Müller
authors.forename: Uwe
authors.initials: U
authors.lastname: Rothenpieler
authors.forename: Peter-Christian
authors.initials: PC
authors.lastname: Flügel
authors.forename: Gunnar
authors.initials: G
authors.lastname: Tepe
authors.forename: Franz-Josef
authors.initials: FJ
authors.lastname: Neumann
mesh_terms: 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