Application of directional atherectomy combined with paclitaxel-coated balloon angioplasty in treatment of femoropopliteal occlusion

doi:10.3877/cma.j.issn.2095-5782.2018.03.010

Abstract

Abstract:

Objective:

To evaluate the safety and effect of directional atherectomy (DA) combined with paclitaxel-coated balloon (PCB) angioplasty in treatment of atherosclerotic lesions in femoropopliteal artery.

Methods:

Seventeen cases with femoropopliteal occlusion[mean age of (73.2±7.5) years-old; 11 male and 6 female] were analyzed. In 14 cases (82%) , the Rutherford level of the affected limb was >4 grade, presented with critical limb ischemia, underwent treatment with DA and PCB angioplasty under filter protection between September 2016 and August 2017. Dual antiplatelet therapy was indicated per-and post-operation. The ankle-brachial index (ABI) was detected before the intervention, after 3, 6 and 12 months. Also clinical examination and target lesion duplex ultrasound scans or computed tomographic angiography (CTA) were done in the observation period.

Results:

There were 17 cases enrolled, the treated lesion length was (286.1±69.4) mm. Successful recanalization of all target lesions, one refractory stenosis was treated with bailout stenting. The technical success rate was 94.1%. In eight cases with toe necrosis before operation, foot finger amputations were performed after procedure, to reach complete wound healing and/or preserve deambulation. The post-operation ABI was significantly higher than per-operation (0.99±0.10 vs. 0.30±0.19, t=15.31, P<0.05) . The mean follow-up was (7.4±3.8) months (3-14 months) . During follow-up, no restenosis requiring re-intervention was found, the primary patency was 100%, and no DA-related adverse event and symptom recurrence was observed, with the limb salvage rate of 100%.

Conclusion:

The DA combined with PCB might be an effective and safe method with a promising high rate of patency.

Key words: Femoropopliteal occlusion, TurboHawk directional atherectomy, Paclitaxel-coated balloon

Zhenai Shi, Chengzhi Li, Hong Zhang, Yulong Liu, Wanghai Li, Yan Zhang. Application of directional atherectomy combined with paclitaxel-coated balloon angioplasty in treatment of femoropopliteal occlusion[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2018, 06(03): 226-231.

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References 21

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病变特点	例(%)
髂-股-腘长段闭塞	3(17.6)
股腘动脉全程闭塞病变	9(52.9)
累及股总动脉的膝下动脉病变	5(29.4)
完全闭塞	12(70.6)
支架内再狭窄/闭塞	13(76.5)

病变特点	例(%)
髂-股-腘长段闭塞	3(17.6)
股腘动脉全程闭塞病变	9(52.9)
累及股总动脉的膝下动脉病变	5(29.4)
完全闭塞	12(70.6)
支架内再狭窄/闭塞	13(76.5)

时点	血管狭窄率(%)	ABI	Rutherford分级
术前	95.59±8.08	0.30±0.19	5(4,6)
术后	14.47±12.60	0.99±0.10	1(0,3)
统计量	t=19.25	t=15.31	Z=3.68
P值	<0.01	<0.01	<0.01

时点	血管狭窄率(%)	ABI	Rutherford分级
术前	95.59±8.08	0.30±0.19	5(4,6)
术后	14.47±12.60	0.99±0.10	1(0,3)
统计量	t=19.25	t=15.31	Z=3.68
P值	<0.01	<0.01	<0.01

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