Diyabetin alt ekstremite kronik total oklüzyonlarında rotasyonel aterektomi ve ilaç kaplı balon sonuçlarına etkisi

Year 2025, Volume: 8 Issue: 4, 674 - 679, 30.07.2025

Ufuk Türkmen

https://doi.org/10.32322/jhsm.1701502

https://izlik.org/JA32CB57XZ

Abstract

Amaç: Bu çalışmanın amacı, rotasyonel aterektomi (RA) ile ilaç kaplı balon (DCB) kombinasyonunun, alt ekstremite arterlerinde kronik total oklüzyon (CTO) bulunan diyabetik ve non-diyabetik hastalardaki teknik başarı, damar açıklığı ve reoklüzyon oranları üzerindeki etkisini değerlendirmektir.
Yöntemler: Ekim 2018–Ekim 2022 tarihleri arasında RA + DCB uygulanan 151 hasta retrospektif olarak incelendi. Hastalar, diyabetik (n=77) ve non-diyabetik (n=74) olmak üzere iki gruba ayrıldı. Teknik başarı, reoklüzyon oranı, primer açıklık ve ayak bileği-kol indeksi (ABI) gibi klinik sonuçlar karşılaştırıldı. Reoklüzyonsuz sağkalım oranları Kaplan-Meier yöntemiyle analiz edildi; gruplar arası fark log-rank testi ile değerlendirildi.
Bulgular: Her iki grupta da teknik başarı oranı %100, stent kullanım oranı <%8 olarak saptandı. Diyabetik hastalarda 12 aylık reoklüzyon oranı %13.0, non-diyabetik hastalarda %5.4 idi (p=0.160). ABI değerlerinde her iki grupta da anlamlı artış gözlendi (p<0.001). Diyabetik grupta medyan ABI 0.60’tan 1.10’a, non-diyabetik grupta 0.60’tan 1.20’ye yükseldi. Gruplar arasında ABI değişim farkı istatistiksel olarak anlamlı değildi (p=0.143). Reoklüzyonsuz sağkalım oranı diyabetik grupta %87.0, non-diyabetik grupta %94.6 idi (p=0.48).
Sonuç: RA + DCB kombinasyonu, hem diyabetik hem de non-diyabetik hastalarda yüksek teknik başarı ve düşük reoklüzyon oranları ile etkili bir tedavi yaklaşımıdır. Özellikle diyabetik grupta reoklüzyon oranları daha yüksek seyretse de, elde edilen ABI artışı tedavinin fonksiyonel etkinliğini göstermektedir. Bu çalışma, RA + DCB stratejisinin yüksek riskli popülasyonda güvenle uygulanabileceğini ve daha ileri prospektif çalışmalar için güçlü bir temel oluşturduğunu ortaya koymaktadır.

Keywords

Rotasyonel aterektomi , İlaç kaplı balon , Kronik total oklüzyon , Periferik arter hastalığı , Diyabet , Ayak bileği-kol indeksi

The impact of diabetes on rotational atherectomy and drug-coated balloon outcomes in lower extremity chronic total occlusions

https://izlik.org/JA32CB57XZ

Abstract

Aims: This study aimed to evaluate the effect of combining rotational atherectomy (RA) and drug-coated balloon (DCB) angioplasty on clinical outcomes in diabetic (DMG) and non-diabetic (NDMG) patients with chronic total occlusions (CTOs) in the lower extremity arteries (LEAs).
Methods: A total of 151 patients treated between 2018 and 2022 were retrospectively analyzed. Patients were categorized as DMG (n=77) and NDMG (n=74). Outcomes such as technical success, vessel patency, re-occlusion, and ankle-brachial index (ABI) were compared between the groups.
Results: Technical success was achieved in all patients, with a stent usage rate below 8%. At 12 months, re-occlusion occurred in 13.0% of DMG and 5.4% of NDMG patients. Both groups showed a significant increase in ABI: from 0.60 to 1.10 in DMG and from 0.60 to 1.20 in NDMG. The 12-month re-occlusion-free survival rate was 87.0% in DMG and 94.6% in NDMG.
Conclusion: RA combined with DCB angioplasty appears to be a safe and effective treatment strategy for CTOs in LEAs. The approach offers high technical success and favorable mid-term outcomes in both diabetic and non-diabetic patients, supporting its use in high-risk populations.

Keywords

Ankle-Brachial Index , chronic total occlusion , diabetes , drug-coated balloon , peripheral artery disease , rotational atherectomy

References

• Urcun YS, Pala AA. Assessment of the efficacy of endovascular treatment in chronic limb-threatening ischemia in diabetic and non-diabetic patients. J Surg Med. 2020;4(11):998-1002. doi:10.28982/josam.811915
• Engin AY, Saydam O. Rotational atherectomy with adjunctive balloon angioplasty in calcified chronic total occlusions of superficial femoral artery. Vascular. 2021;29(5):682-692. doi:10.1177/1708538120970817
• Lowry D, Saeed M, Narendran P, Tiwari A. A review of distribution of atherosclerosis in the lower limb arteries of patients with diabetes mellitus and peripheral vascular disease. Vasc Endovascular Surg. 2018; 52(7):535-542. doi:10.1177/1538574418791622
• Teichgräber U, Lehmann T, Aschenbach R, et al. Drug-coated balloon angioplasty of femoropopliteal lesions maintained superior efficacy over conventional balloon: 2-year results of the randomized EffPac trial. Radiology. 2020;295(2):478-487. doi:10.1148/radiol.2020191619
• Böhme T, Noory E, Beschorner U, et al. Matched comparison of uncoated and paclitaxel-coated balloon angioplasty for isolated popliteal lesions excluding bail-out stenting. Cardiovasc Revasc Med. 2024;63:54-58. doi: 10.1016/j.carrev.2024.01.004
• Shammas NW, Purushottam B, Shammas WJ, et al. Jetstream atherectomy followed by paclitaxel-coated balloons versus balloon angioplasty followed by paclitaxel-coated balloons: twelve-month exploratory results of the prospective randomized JET-RANGER study. Vasc Health Risk Manag. 2022;18:603-615. doi:10.2147/VHRM.S371177
• Gumus F, Arslanturk O. Usage of rotational atherectomy and drug-coated balloon angioplasty for isolated popliteal artery lesions: two-year results of a retrospective study. Acta Chir Belg. 2024;124(5):365-371. doi: 10.1080/00015458.2024.2313266
• Zeller T, Langhoff R, Rocha-Singh KJ, 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. doi:10.1161/CIRCINTERVENTIONS.116.004848
• Stavroulakis K, Bisdas T, Torsello G, Stachmann A, Schwindt A. Combined directional atherectomy and drug-eluting balloon angioplasty for isolated popliteal artery lesions in patients with peripheral artery disease. J Endovasc Ther. 2015;22(6):847-852.
• Troisi N, Saratzis A, Katsogridakis E, et al. Different endovascular modalities of treatment for isolated atherosclerotic popliteal artery lesions (EMO-POP) registry. J Vasc Surg. 2023;77(1):231-240. doi:10.1016/j.jvs.2022.07.170
• Ulukan MÖ, Karakaya A, Uğurlucan M, Erkanlı K. Two-year outcomes in patients undergoing rotational atherectomy and drug coated balloon therapy for chronic total occluded peripheral arterial diseases: a retrospective cohort study. J Surg Med. 2021;5(9):960-963. doi:10.28982/josam.980212
• Cioppa A, Stabile E, Popusoi G, 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):219-223. doi:10.1016/j.carrev.2012. 04.007
• Yiğit G. Early outcomes of novel Temren atherectomy device combined with drug-coated balloon angioplasty for treatment of femoropopliteal lesions. Vascular. 2022;30(4):739-748. doi:10.1177/17085381211029819
• Bai H, Fereydooni A, Zhuo H, et al. Comparison of atherectomy to balloon angioplasty and stenting for isolated femoropopliteal revascularization. Ann Vasc Surg. 2020;69:261-273. doi:10.1016/j.avsg. 2020.05.019
• Kokkinidis DG, Behan S, Jawaid O, et al. Laser atherectomy and drug-coated balloons for the treatment of femoropopliteal in-stent restenosis: 2-year outcomes. Catheter Cardiovasc Interv. 2020;95(3):439-446. doi:10.1002/ccd.28636
• Foley TR, Cotter RP, Kokkinidis DG, Nguyen DD, Waldo SW, Armstrong EJ. Mid-term outcomes of orbital atherectomy combined with drug-coated balloon angioplasty for treatment of femoropopliteal disease. Catheter Cardiovasc Interv. 2017;89(6):1078-1085. doi:10.1002/ccd.26984
• Morosetti D, Chiocchi M, Argirò R, et al. Endovascular treatment of calcific lesions of the common femoral artery using atherectomy device associated with scoring balloon angioplasty in diabetic patients with high “major amputation” risk. Vascular. 2022;30(3):463-473. doi:10. 1177/17085381211019244
• Neupane S, Edla S, Maidona E, et al. Long-term outcomes of patients with diabetes mellitus undergoing percutaneous intervention for popliteal and infrapopliteal peripheral arterial disease. Catheter Cardiovasc Interv. 2018;92(1):117-123. doi:10.1002/ccd.27571
• Katsanos K, Spiliopoulos S, Reppas L, Karnabatidis D. Debulking atherectomy in the peripheral arteries: is there a role and what is the evidence? Cardiovasc Intervent Radiol. 2017;40(7):964-977. doi:10.1007/s00270-017-1649-6