Treating peripheral arterial disease percutaneously with atherectomy.
OBJECTIVE
To determine clinical outcomes of patients who underwent percutaneous revascularization (PR) with multiple devices.


METHODS
PR cases at a private, tertiary referral hospital were reviewed retrospectively. Limb salvage and patency rates were calculated by the Kaplan Meier method. Historical and procedural factors were analyzed by multivariate Cox proportional hazards models.


RESULTS
We identified 66 patients and 87 limbs with 261 lesions, including 38 patients with critical limb ischemia (CLI) (51 limbs, 171 lesions). PR incorporated multiple devices (2.0 ± 1.2 devices/lesion, 2.4 ± 1.6 devices/procedure), including balloon angioplasty (57%), excisional atherectomy (54%), orbital atherectomy (44%), and stenting (13%). Last imaged patency was at 18 ± 13 months and last clinical follow-up was 22 ± 12 months. Thirty-five of 87 limbs had ≥1 repeat PR. In 51 limbs with CLI, limb salvage was 75% at 3 years. Independent predictors of amputation were higher creatinine (P=.01; hazard ratio [HR], 1.4), Rutherford category (P=.03; HR, 3.5), and history of coronary artery bypass graft (CABG) (P=.03; HR, 8.9). Overall patency remained 75% through 3 years. Loss of patency or primary patency (patency without repeat PR) was predicted by higher creatinine, Rutherford category, chronic total occlusion, history of CABG, female gender, current and past smoking. Use of excisional atherectomy maintained overall patency (P=.01; HR, 0.36).


CONCLUSIONS
An aggressive approach to PR with frequent use of atherectomy resulted in high rates of limb salvage and patency. Smoking cessation and excisional atherectomy may improve patency rates.
Heart Institute, Good Samaritan Hospital, Los Angeles, CA 90017-2395, USA. bschwartz15@hotmail.com
Bryan G
BG
Schwartz
Robert A
RA
Kloner
Steven
S
Burstein
Christina
C
Economides
Guy S
GS
Mayeda
D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D000800:Angioplasty, Balloon / Q000379:methods*; D017073:Atherectomy / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage / Q000379:methods*; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy*; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods; D014654:Vascular Patency / Q000502:physiology