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Use of the directional atherectomy for the treatment of femoro-popliteal lesions in patients with critical lower limb ischemia

View Article: PubMed Central - PubMed

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.

Conclusion: 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.

No MeSH data available.


Related in: MedlinePlus

A. intraoperative image showing Turbohawk™ device and distal protection filter SpiderFX™. B. Long trimmed plaque.
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f2-tm-15-42: A. intraoperative image showing Turbohawk™ device and distal protection filter SpiderFX™. B. Long trimmed plaque.

Mentions: All procedures were performed under local anaesthesia with the patient in a supine position. Vascular access was percutaneously achieved via the ipsilateral common femoral artery. In two cases a surgical cut-down was necessary, with a purse string suture positioning on the artery before the puncture; one due to the patient’s obesity (BMI 32 Kg/m2) and the other to treat an SFA ostial lesion. An 8 Fr sheath was advanced antegradely in all 18 patients’ SFA in order to achieve adequate support. Once diagnostic angiography was completed, a 0.014″ guidewire was advanced into the distal popliteal artery. A filter for embolic protection (Spider FX™ embolic protection device (EPD), Covidien, Plymouth, MN) was positioned distal to the stenosis. Filter size was chosen according to landing artery diameter. DCA was performed using the Turbohawk™ device; a monorail exchange system running over a 0.014″ guidewire which was chosen out of the 7 diameters and catheter lengths available to treat the femoral, popliteal and below the knee vessels. The device consists of a plaque blade cutter and reservoir at the tip, which stores the trimmed plaque. Under fluoroscopic guidance we advanced the device across the lesions at a speed of 1–2 mm per second with the cutting blade in constant orientation against the eccentric plaque, thereby avoiding circular movements. The cutting sequence was repeated as necessary in order to excise the largest amount of plaque possible (Fig. 1) (Fig. 2) (Fig. 3). Self-expanding nitinol stent implantation was permitted for bailout stenting (residual stenosis > 30% or flow limiting dissections). Lesion pre-dilation was left at operator’s discretion.


Use of the directional atherectomy for the treatment of femoro-popliteal lesions in patients with critical lower limb ischemia
A. intraoperative image showing Turbohawk™ device and distal protection filter SpiderFX™. B. Long trimmed plaque.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120749&req=5

f2-tm-15-42: A. intraoperative image showing Turbohawk™ device and distal protection filter SpiderFX™. B. Long trimmed plaque.
Mentions: All procedures were performed under local anaesthesia with the patient in a supine position. Vascular access was percutaneously achieved via the ipsilateral common femoral artery. In two cases a surgical cut-down was necessary, with a purse string suture positioning on the artery before the puncture; one due to the patient’s obesity (BMI 32 Kg/m2) and the other to treat an SFA ostial lesion. An 8 Fr sheath was advanced antegradely in all 18 patients’ SFA in order to achieve adequate support. Once diagnostic angiography was completed, a 0.014″ guidewire was advanced into the distal popliteal artery. A filter for embolic protection (Spider FX™ embolic protection device (EPD), Covidien, Plymouth, MN) was positioned distal to the stenosis. Filter size was chosen according to landing artery diameter. DCA was performed using the Turbohawk™ device; a monorail exchange system running over a 0.014″ guidewire which was chosen out of the 7 diameters and catheter lengths available to treat the femoral, popliteal and below the knee vessels. The device consists of a plaque blade cutter and reservoir at the tip, which stores the trimmed plaque. Under fluoroscopic guidance we advanced the device across the lesions at a speed of 1–2 mm per second with the cutting blade in constant orientation against the eccentric plaque, thereby avoiding circular movements. The cutting sequence was repeated as necessary in order to excise the largest amount of plaque possible (Fig. 1) (Fig. 2) (Fig. 3). Self-expanding nitinol stent implantation was permitted for bailout stenting (residual stenosis > 30% or flow limiting dissections). Lesion pre-dilation was left at operator’s discretion.

View Article: PubMed Central - PubMed

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.

Conclusion: 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.

No MeSH data available.


Related in: MedlinePlus