Long-term Results of the Combined Use of Rotational Atherectomy and Drug-Coated Balloon in Isolated Total Occlusion of the Superficial Femoral Artery

Yıl 2020, Cilt: 25 Sayı: 3, 200 - 205, 29.10.2020

Fatih Avni Bayraktar , Cemal Kocaaslan , Mehmet Şenel Bademci , Emre Selçuk Ebuzer Aydın

https://doi.org/10.21673/anadoluklin.755247

Cited By: 1

Öz

Aim: In this study, we aimed to evaluate the long-term results of combined treatment with rotational atherectomy (RA) and drug-coated balloon (DCB) in isolated total occlusion of the superficial femoral artery (SFA).

Materials and Methods: The retrospective study was conducted between February 2016 and January 2018 and included a total of 23 limbs of 20 patients with isolated total occlusion of the SFA. Patient data on demographic and clinical characteristics were obtained from the hospital records. The stage of the disease was classified according to the Rutherford classification. The ankle–brachial index was measured pre- and postoperatively.

Results: Of the patients, 19 (95%) were male and one (5%) was female. The mean patient age was 67.40±7.50 (49–77) years. The patient distribution according to the preoperative Rutherford classification was as follows: stage 5, four (17.40%) patients; stage 4, eight (34.80%) patients; stage 3, eleven (47.80%) patients. The rates of one- and two-year freedom from target lesion revascularization were 82.61% and 69.57%, respectively.

Discussion and Conclusion: Our study results showed that combined treatment with RA and DCB was an effective method in SFA lesions with a high calcified plaque burden, providing high rates of primary patency and freedom from target lesion revascularization as well as low rates of complication.

Anahtar Kelimeler

Angioplasty, atherectomy, peripheral arterial disease

Yüzeyel Femoral Arterin İzole Total Oklüzyonunda Rotasyonel Aterektomi ve İlaç Kaplı Balon Kombine Kullanımının Uzun Dönem Sonuçları

Öz

Amaç: Bu çalışmada yüzeyel femoral arterin (YFA) izole total oklüzyonunda rotasyonel aterektomi (RA) ve ilaç kaplı balon (İKB) ile kombine tedavinin uzun dönem sonuçlarını değerlendirmek amaçlanmıştır.

Gereç ve Yöntemler: Retrospektif çalışmamız Şubat 2016—Ocak 2018 döneminde gerçekleştirildi ve izole total YFA oklüzyonu olan 20 hastanın toplam 23 uzvunu içerdi. Demografik ve klinik özelliklere dair hasta verileri hastane kayıtlarından elde edildi. Hastalığın evresi Rutherford sınıflamasına göre sınıflandırıldı. Ayak bileği–kol indeksi müdahaleden önce ve sonra ölçüldü.

Bulgular: Hastaların 19’u (%95) erkek, 1’i (%5) kadındı. Ortalama hasta yaşı 67,40±7,50 (49–77) yıl idi. Preoperatif Rutherford sınıflamasına göre hasta dağılımı şu şekildeydi: evre 5, dört (%17,40) hasta; evre 4, sekiz (%34,80) hasta; evre 3, on bir (%47,80) hasta. Bir yıllık ve iki yıllık hedef lezyon revaskülarizasyonundan kurtulma oranları sırasıyla %82,61 ve %69,57 idi.

Tartışma ve Sonuç: Çalışma sonuçlarımız RA ve İKB ile kombine tedavinin kalsifik plak yükü fazla olan YFA lezyonlarında gerek yüksek primer açıklık ve yüksek hedef lezyon revaskülarizasyonundan kurtulma oranları gerekse düşük komplikasyon oranları ile etkili bir yöntem olduğunu göstermektedir.

Anahtar Kelimeler

anjiyoplasti, aterektomi, periferik arteriyel hastalık

Kaynakça

• 1. Aldağ M, Öztekin A, Bademci MŞ, Kocaaslan C, Yalvaç EŞD, Aydın E. Surgical results of acute thromboembolic limb ischemia in octogenarians. Turk J Vasc Surg. 2018;27(3):111–6.
• 2. Fanelli F, Cannavale A, Gazzetti M, Lucatelli P, Wlderk A, Cirelli C, et al. Calcium burden assessment and impact on drug-eluting balloons in peripheral arterial disease. Cardiovasc Intervent Radiol. 2014;37(4):898–907.
• 3. McKinsey JF, Zeller T, Rocha-Singh KJ, Jaff MR, Garcia LA, DEFINITIVE LE Investigators. Lower extremity revascularization using directional atherectomy: 12-month prospective results of the DEFINITIVE LE study. JACC Cardiovasc Interv. 2014;7(8):923–93.
• 4. Sixt S, Carpio Cancino OG, Treszl A, Beschorner U, Macharzina R, Rastan A, et al. Drug-coated balloon angioplasty after directional atherectomy improves outcome in restenotic femoropopliteal arteries. J Vasc Surg. 2013;58(3):682–6.
• 5. Tepe G, Laird J, Schneider P, Brodmann M, Krishnan P, Micari A, et al. Drug-coated balloon versus standard percutaneous transluminal angioplasty for the treatment of superficial femoral and popliteal peripheral artery disease: 12-month results from the IN.PACT SFA randomized trial. Circulation. 2015;131(5):495–502.
• 6. Rosenfield K, Jaff MR, White CJ, Rocha-Singh K, Mena-Hurtado C, Metzger DC, et al. Trial of a paclitaxel-coated balloon for femoropopliteal artery disease. N Engl J Med. 2015;373(2):145–53.
• 7. Shammas NW, Coiner D, Shammas GA, Dippel EJ, Christensen L, Jerin M. Percutaneous lower-extremity arterial interventions with primary balloon angioplasty versus Silverhawk atherectomy and adjunctive balloon angioplasty: randomized trial. J Vasc Interv Radiol. 2011;22(9):1223–8.
• 8. Dattilo R, Himmelstein SI, Cuff RF. The COMPLIANCE 360° Trial: a randomized, prospective, multicenter, pilot study comparing acute and long-term results of orbital atherectomy to balloon angioplasty for calcified femoropopliteal disease. J Invasive Cardiol. 2014;26(8):355–60.
• 9. Tepe G, Beschorner U, Ruether C, Fischer I, Pfaffinger P, Noory E, et al. Drug-eluting balloon therapy for femoropopliteal occlusive disease: predictors of outcome with a special emphasis on calcium. J Endovasc Ther. 2015;22(5):727–33.
• 10. Zeller T, Langhoff R, Rocha-Singh KJ, Jaff MR, Blessing E, Amann-Vesti B, et al. Directional atherectomy followed by a paclitaxel-coated balloon to inhibit restenosis and maintain vessel patency: twelve-month results of the DEFINITIVE AR Study. Circ Cardiovasc Interv. 2017;10(9):e004848.
• 11. Kim TH, Katsetos M, Dahal K, Azrin M, Lee J. Use of rotational atherectomy for reducing significant dissection in treating de novo femoropopliteal steno-occlusive disease after balloon angioplasty. J Geriatr Cardiol. 2018;15(4):254–60.
• 12. Tzafriri AR, Zani B, Stanley J, Markham P, Nikanorov A, Edelman ER. TCT-794 lesion preparation with an orbital atherectomy system enhances paclitaxel deposition in calcified peripheral arteries. J Am Coll Cardiol. 2015;66(15 Supplement):B323.
• 13. Cioppa A, Stabile E, Popusoi G, Salemme L, Cota L, Pucciarelli A, et al. Combined treatment of heavy calcified femoro-popliteal lesions using directional atherectomy and a paclitaxel coated balloon: one-year single centre clinical results. Cardiovasc Revasc Med. 2012;13(4):219–23.
• 14. Aydın S. Combined use of atherectomy and drug-coated balloon for endovascular treatment of femoropopliteal artery disease. Turk J Vasc Surg. 2019;28(2):84–90.
• 15. Shammas NW, Shammas GA, Jones-Miller S, Shammas WJ, Bou-Dargham B, Shammas AN, et al. Long-term outcomes with Jetstream atherectomy with or without drug coated balloons in treating femoropopliteal arteries: a single center experience (JET-SCE). Cardiovasc Revasc Med. 2018;19(7):771–7.