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.


Reference

Hirsch AT., Criqui MH., Treat-Jacobson D., Regensteiner JG., Creager MA., Olin JW, et al. 2001. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 286:1317–24. DOI: 10.1001/jama.286.11.1317. PMID: 11560536.
Article
Goodney PP., Beck AW., Nagle J., Welch HG., Zwolak RM. 2009. National trends in lower extremity bypass surgery, endovascular interventions, and major amputations. J Vasc Surg. 50:54–60. DOI: 10.1016/j.jvs.2009.01.035. PMID: 19481407.
Article
Park YY., Joh JH., Han SA., Kim SH., Cho S., Park HC, et al. 2015. National trends for the treatment of peripheral arterial disease in Korea between 2004 and 2013. Ann Surg Treat Res. 89:319–24. DOI: 10.4174/astr.2015.89.6.319. PMID: 26665127. PMCID: PMC4672096.
Article
Gardiner GA Jr Jr., Bonn J., Sullivan KL. 2001. Quantification of elastic recoil after balloon angioplasty in the iliac arteries. J Vasc Interv Radiol. 12:1389–93. DOI: 10.1016/S1051-0443(07)61694-7. PMID: 11742011.
Article
Shammas NW., Coiner D., Shammas GA., Dippel EJ., Christensen L., Jerin M. 2011. Percutaneous lower-extremity arterial interventions with primary balloon angioplasty versus Silverhawk atherectomy and adjunctive balloon angioplasty: randomized trial. J Vasc Interv Radiol. 22:1223–8. DOI: 10.1016/j.jvir.2011.05.013. PMID: 21757372.
Article
Schillinger M., Sabeti S., Loewe C., Dick P., Amighi J., Mlekusch W, et al. 2006. Balloon angioplasty versus implantation of nitinol stents in the superficial femoral artery. N Engl J Med. 354:1879–88. DOI: 10.1056/NEJMoa051303. PMID: 16672699.
Article
Laird JR., Katzen BT., Scheinert D., Lammer J., Carpenter J., Buchbinder M, et al. RESILIENT Investigators. 2010. Nitinol stent implantation versus balloon angioplasty for lesions in the superficial femoral artery and proximal popliteal artery: twelve-month results from the RESILIENT randomized trial. Circ Cardiovasc Interv. 3:267–76. DOI: 10.1161/CIRCINTERVENTIONS.109.903468. PMID: 20484101.
Garcia LA., Lyden SP. 2009. Atherectomy for infrainguinal peripheral artery disease. J Endovasc Ther. 16(2 Suppl 2):II105–15. DOI: 10.1583/08-2656.1. PMID: 19624078.
Article
Zierler RE., Jordan WD., Lal BK., Mussa F., Leers S., Fulton J, et al. 2018. The Society for Vascular Surgery practice guidelines on follow-up after vascular surgery arterial procedures. J Vasc Surg. 68:256–84. DOI: 10.1016/j.jvs.2018.04.018. PMID: 29937033.
Article
Zeller T., Rastan A., Schwarzwälder U., Frank U., Bürgelin K., Amantea P, et al. 2004. Percutaneous peripheral atherectomy of femoropopliteal stenoses using a new-generation device: six-month results from a single-center experience. J Endovasc Ther. 11:676–85. DOI: 10.1583/04-1316R.1. PMID: 15615558.
Roberts D., Niazi K., Miller W., Krishnan P., Gammon R., Schreiber T, et al. 2014. Effective endovascular treatment of calcified femoropopliteal disease with directional atherectomy and distal embolic protection: final results of the DEFINITIVE Ca++ trial. Catheter Cardiovasc Interv. 84:236–44. DOI: 10.1002/ccd.25384. PMID: 24402764. PMCID: PMC4282091.
Shammas NW., Dippel EJ., Coiner D., Shammas GA., Jerin M., Kumar A. 2008. Preventing lower extremity distal embolization using embolic filter protection: results of the PROTECT registry. J Endovasc Ther. 15:270–6. DOI: 10.1583/08-2397.1. PMID: 18540705.
Article
Shammas NW., Coiner D., Shammas GA., Christensen L., Dippel EJ., Jerin M. 2009. Distal embolic event protection using excimer laser ablation in peripheral vascular interventions: results of the DEEP EMBOLI registry. J Endovasc Ther. 16:197–202. DOI: 10.1583/08-2642.1. PMID: 19456199.
Article
Lam RC., Shah S., Faries PL., McKinsey JF., Kent KC., Morrissey NJ. 2007. Incidence and clinical significance of distal embolization during percutaneous interventions involving the superficial femoral artery. J Vasc Surg. 46:1155–9. DOI: 10.1016/j.jvs.2007.07.058. PMID: 18154991.
Article
Davies MG., Bismuth J., Saad WE., Naoum JJ., Mohiuddin IT., Peden EK, et al. 2010. Implications of in situ thrombosis and distal embolization during superficial femoral artery endoluminal intervention. Ann Vasc Surg. 24:14–22. DOI: 10.1016/j.avsg.2009.06.020. PMID: 19748214.
Article
Baril DT., Rhee RY., Kim J., Makaroun MS., Chaer RA., Marone LK. 2009. Duplex criteria for determination of in-stent stenosis after angioplasty and stenting of the superficial femoral artery. J Vasc Surg. 49:133–8. discussion 139. DOI: 10.1016/j.jvs.2008.09.046. PMID: 19174252.
Article
Shrikhande GV., Graham AR., Aparajita R., Gallagher KA., Morrissey NJ., McKinsey JF, et al. 2011. Determining criteria for predicting stenosis with ultrasound duplex after endovascular intervention in infrainguinal lesions. Ann Vasc Surg. 25:454–60. DOI: 10.1016/j.avsg.2010.12.017. PMID: 21549912.
Article
Bui TD., Mills JL Sr., Ihnat DM., Gruessner AC., Goshima KR., Hughes JD. 2012. The natural history of duplex-detected stenosis after femoropopliteal endovascular therapy suggests questionable clinical utility of routine duplex surveillance. J Vasc Surg. 55:346–52. DOI: 10.1016/j.jvs.2011.08.010. PMID: 21975061.
Article
Smolock CJ., Anaya-Ayala JE., Kaufman Y., Bavare CS., Patel MS., El-Sayed HF, et al. 2013. Current efficacy of open and endovascular interventions for advanced superficial femoral artery occlusive disease. J Vasc Surg. 58:1267–75. e1-2. DOI: 10.1016/j.jvs.2013.02.252. PMID: 24160311.
Article
Graziani L., Piaggesi A. 2010. Indications and clinical outcomes for below knee endovascular therapy: review article. Catheter Cardiovasc Interv. 75:433–43. DOI: 10.1002/ccd.22287. PMID: 19937784.
Article
Saqib NU., Domenick N., Cho JS., Marone L., Leers S., Makaroun MS, et al. 2013. Predictors and outcomes of restenosis following tibial artery endovascular interventions for critical limb ischemia. J Vasc Surg. 57:692–9. DOI: 10.1016/j.jvs.2012.08.115. PMID: 23351646.
Article
Fernandez N., McEnaney R., Marone LK., Rhee RY., Leers S., Makaroun M, et al. 2010. Predictors of failure and success of tibial interventions for critical limb ischemia. J Vasc Surg. 52:834–42. DOI: 10.1016/j.jvs.2010.04.070. PMID: 20619586. PMCID: PMC4076901.
Article
Full Text Links
  • JSU
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr