title: Use of the directional atherectomy for the treatment of femoro-popliteal lesions in patients with critical lower limb ischemia.
abstract: Femoro-popliteal PTA for the treatment of critical limb ischemia is frequently associated with unsatisfactory procedural success rates while directional atherectomy (DCA) has improved success rate since claudicant patients undergoing percutaneous treatment of femoro-popliteal obstructive disease. The aim of this prospective study is to evaluate the safety, efficacy and procedural success of DCA, at one year, in the percutaneous treatment of femoro-popliteal obstructive disease in patients with critical limb ischemia.
  
  
  METHODS
  From March 2012 to March 2013 18 consecutive patients with critical limb ischemia were treated with DCA (Turbohawk/Covidien-ev3 Endovascular Inc., North Plymouth, Minnesota, USA) for the treatment of femoro-popliteal obstructive disease. Patients were evaluated at 12 months.
  
  
  RESULTS
  Technical and procedural success was achieved in every patient. No in-hospital major adverse cardiovascular events occurred. Primary endpoint: freedom from any amputation was obtained in all patients. Secondary endpoints: clinical (Rutherford class improvement) and hemodynamic success (Ankle-brachial index improvement) was achieved in all patients.
  
  
  CONCLUSIONS
  The use of DCA for the treatment of femoro-popliteal obstructive disease is a safe and effective therapeutic strategy for patients with critical limb ischemia. The data included in our study should be considered hypothesis-generating in order to design of a randomized trial comparison with conventional PTA.
authors.affiliation: Department of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy.
authors.forename: Umberto Marcello
authors.initials: UM
authors.lastname: Bracale
authors.affiliation: Department of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy; Vascular Surgery Unit, University of Palermo, Palermo, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Vitale
authors.affiliation: Vascular Surgery Unit, University of Palermo, Palermo, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Bajardi
authors.affiliation: Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy.
authors.forename: Donatella
authors.initials: D
authors.lastname: Narese
authors.affiliation: Vascular Surgery Unit, University of Palermo, Palermo, Italy.
authors.forename: Ettore
authors.initials: E
authors.lastname: Dinoto
authors.affiliation: Department of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Giribono
authors.affiliation: Department of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy.
authors.forename: Doriana
authors.initials: D
authors.lastname: Ferrara
authors.affiliation: Department of Vascular and Endovascular Surgery, University Federico II of Naples, Naples, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Del Guercio
authors.affiliation: Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Midiri
authors.affiliation: Vascular Surgery Unit, University of Palermo, Palermo, Italy.
authors.forename: Felice
authors.initials: F
authors.lastname: Pecoraro
keywords: Turbohawk device; atherectomy; critical limb ischemia; endovascular treatment