title: A critical view of the peripheral atherectomy data in the treatment of infrainguinal arterial disease.
abstract: BACKGROUND
  Revascularization of the peripheral arteries remains technically challenging. By decreasing the volume of the atherosclerotic plaque, debulking procedures may confer superior primary patency after revascularization.
  
  
  OBJECTIVE
  To assess the impact of atherectomy on primary patency rates at 12 months compared to balloon angioplasty and/or stent placement alone in patients with infrainguinal arterial disease.
  
  
  METHODS
  A database search for "directional," "orbital," "rotational," and "laser atherectomy" in peripheral arterial disease (PAD) was performed. Studies were screened according to the STROBE (Strengthening the Reporting of Observational studies in Epidemiology) critical appraisal tool and summarized by population, methodology, and outcomes (primary patency and major adverse events).
  
  
  RESULTS
  Only two randomized studies were found. Most of the data were obtained from single-arm studies and registries. The primary patency with directional atherectomy approaches 60% at 12 months as a stand-alone technique, whereas orbital atherectomy in conjunction with balloon angioplasty and stenting achieved primary patency rates of 90%. Laser atherectomy is universally employed with balloon angioplasty and stenting for in-stent restenosis lesions with a primary patency rate of 64%. Although there are data for the safe use of rotational atherectomy, robust data to support its effectiveness are lacking. The combination of drug-coated balloons and atherectomy for the treatment of heavily calcified lesions in patients with critical limb ischemia is under evaluation.
  
  
  CONCLUSIONS
  Despite the successful procedural outcomes reported in clinical registries, the available data do not support the use of atherectomy alone in PAD. Larger randomized controlled studies are warranted to define its role in contemporary endovascular practice.
authors.affiliation: Tulane University Heart and Vascular Institute, 1430 Tulane Ave., SL-48, New Orleans, LA 70112 USA. nabirafe@tulane.edu.
authors.forename: Henry C
authors.initials: HC
authors.lastname: Quevedo
authors.forename: Salman A
authors.initials: SA
authors.lastname: Arain
authors.forename: Gholam
authors.initials: G
authors.lastname: Ali
authors.forename: Nidal
authors.initials: N
authors.lastname: Abi Rafeh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D017073:Atherectomy / Q000379:methods*; D003131:Combined Modality Therapy; D016208:Databases, Factual; D006801:Humans; D007264:Inguinal Canal / Q000098:blood supply*; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000503:physiopathology* / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology*