J Surg Ultrasound.  2019 Nov;6(2):46-52. 10.0000/jsu.2019.6.2.46.

Duplex Surveillance after Primary Balloon Angioplasty or Directional Atherectomy for Treating Infrainguinal Arterial Disease

Affiliations
  • 1Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea. jhjoh@khu.ac.kr

Abstract

PURPOSE
Percutaneous transluminal angioplasty (PTA) shows an attractive outcome for treating infrainguinal arterial occlusive disease (IAOD). However, this procedure requires repeated revascularization and additional stenting. Directional atherectomy (DA) has been reported to be a modality that requires less frequent use of stenting. The aim of this study was to compare the duplex-based outcomes between PTA and DA for treating IAOD.
METHODS
A retrospective review of consecutive patients with IAOD treated with PTA and DA was completed. The demographics and procedural data were obtained. A provisional stent was placed in those cases with flow-limiting dissection and residual stenosis after PTA or DA. Technical success was defined as a residual stenosis < 30%. The primary patency rate was evaluated by performing duplex scanning. The clinical outcomes and frequency of stent placement for each procedure were evaluated. For statistical analysis, the data was analyzed using SPSS 22.0 software (IBM Corp, Chicago, Ill). All P values were considered significant if less than 0.05.
RESULTS
Seventy-one patients were included in the study. Their mean age was 71.5 ± 10.2 years. The male-to-female ratio was 49:22. Thirty-three patients underwent PTA. DA was performed in 38 patients (42 limbs). Technical success was achieved in all the patients. The duplex-based clinical outcome and limb salvage rate were similar in the two groups. Bailout stent placement was performed in 8 of 33 patients (24.2%) in the PTA group and in no patient in the DA group.
CONCLUSION
The clinical outcomes were similar for both the DA and primary PTA groups. Atherectomy reduced the need for bailout stent placement as compared with bailout stent placement in primary PTA.

Keyword

Transluminal angioplasty; Percutaneous atherectomy; Atherosclerosis; Stent; Duplex scan

MeSH Terms

Angioplasty
Angioplasty, Balloon*
Arterial Occlusive Diseases
Atherectomy*
Atherosclerosis
Constriction, Pathologic
Demography
Humans
Limb Salvage
Retrospective Studies
Stents

Figure

  • Fig. 1 Flow chart of the procedures performed during the study period.

  • Fig. 2 Primary patency rate measured by duplex scanning of two groups. PTA = percutaneous transluminal angioplasty.

  • Fig. 3 Primary patency rate measured by duplex scanning depending on the lesion length.


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