title: Combined Directional Atherectomy and Drug-Eluting Balloon Angioplasty for Isolated Popliteal Artery Lesions in Patients With Peripheral Artery Disease.
abstract: OBJECTIVE
  To evaluate the midterm results of combined directional atherectomy (DA) and drug-eluting balloon (DEB) angioplasty for atherosclerotic lesions of the popliteal artery.
  
  
  METHODS
  In a single-arm, prospective study, 21 patients (mean age 63±16 years; 16 men) with isolated popliteal artery lesions were enrolled and underwent treatment with combined DA and DEB angioplasty under filter protection between October 2009 and February 2014. The majority (18, 86%) presented with lifestyle-limiting intermittent claudication and 3 with critical limb ischemia. Fifteen (71%) target sites were de novo lesions; 4 were occlusions. The main outcome was primary patency; secondary outcomes were technical success, secondary patency, and early and midterm morbidity and mortality.
  
  
  RESULTS
  The TurboHawk atherectomy device was used in 15 (71%) patients and the SilverHawk peripheral plaque excision system in the remaining 6 patients. The In.Pact Admiral/Pacific DEB was used in the majority of cases (15, 71%). The technical success rate was 90% (n=19). One flow-limiting dissection was treated with bailout stenting. Complications included a perforation of the popliteal artery and 2 puncture site hematomas; there was no distal embolic event. The mean follow-up was 18±12 months. Two restenoses were retreated successfully. Kaplan-Meier estimates of primary patency at 12 and 18 months were 95% and 90%, respectively; the secondary patency was 100%. One (5%) patient died in follow-up. None of the patients had an amputation.
  
  
  CONCLUSIONS
  In this prospective single-arm study, the combined therapy of DA and DEB angioplasty for popliteal artery lesions showed promising midterm performance. The combination of DA and DEB may, in highly selected patients, overcome the challenges presented by the mobility of the knee joint.
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Münster, Germany Department of Vascular Surgery, St. Franziskus-Hospital, Münster, Germany stavroulakis.konstantinos@yahoo.gr.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Stavroulakis
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Münster, Germany Department of Vascular Surgery, St. Franziskus-Hospital, Münster, Germany.
authors.forename: Theodosios
authors.initials: T
authors.lastname: Bisdas
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Münster, Germany Department of Vascular Surgery, St. Franziskus-Hospital, Münster, Germany.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Torsello
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Münster, Germany Department of Vascular Surgery, St. Franziskus-Hospital, Münster, Germany.
authors.forename: Arne
authors.initials: A
authors.lastname: Stachmann
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Münster, Germany Department of Vascular Surgery, St. Franziskus-Hospital, Münster, Germany.
authors.forename: Arne
authors.initials: A
authors.lastname: Schwindt
mesh_terms: D000800:Angioplasty, Balloon; D017073:Atherectomy / Q000379:methods*; D050197:Atherosclerosis / Q000601:surgery*; D003131:Combined Modality Therapy; D016503:Drug Delivery Systems; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000188:drug therapy* / Q000601:surgery*; D011150:Popliteal Artery; D011446:Prospective Studies
keywords: atherectomy; drug-eluting balloon; peripheral artery disease; plaque excision; popliteal artery; restenosis