Technical performance and reproducibility following rotational atherectomy of femoropopliteal artery occlusive lesions: analysis of the multicenter MORPHEAS Registry.

Autor:	Donas KP; Department of Vascular and Endovascular Surgery, Asklepios Clinic Langen, Goethe-University of Frankfurt, Langen, Germany - konstantinos.donas@gmail.com., Taneva GT; Department of Vascular and Endovascular Surgery, Asklepios Clinic Langen, Goethe-University of Frankfurt, Langen, Germany., Pitoulias GA; School of Medicine, Division of Vascular Surgery, Second Department of Surgery, G. Gennimatas Hospital, Aristotle University Thessaloniki, Thessaloniki, Greece., Jomha A; Department of Vascular Surgery., Schröder M; Klinicum Bad Hersfeld, University of Giessen, Bad Hersfeld, Germany., Psyllas A; Clinic of Vascular Surgery, Marien Hospital Herne, Ruhr-University of Bochum, Herne, Germany., Scali S; Department of Vascular Surgery, Marien Hospital Wesel, University of Cologne, Wesel, Germany., Abu Bakr N; Department of Vascular and Endovascular Surgery, Asklepios Clinic Langen, Goethe-University of Frankfurt, Langen, Germany.
Jazyk:	angličtina
Zdroj:	The Journal of cardiovascular surgery [J Cardiovasc Surg (Torino)] 2022 Feb; Vol. 63 (1), pp. 13-19.
DOI:	10.23736/S0021-9509.21.12159-7
Abstrakt:	Background: The purpose of this study was to define patient and anatomical factors associated with technical results specific to rotational atherectomy. Controversy exists surrounding appropriate utilization of atherectomy to treat femoral-popliteal atherosclerosis. Importantly, the existence of different atherectomy devices and lack of technical reports highlighting variables that impact outcomes obscures the ability to assess perioperative performance. Methods: The nonindustry sponsored, Multicentric National Registry on the use of rotational atherectomy in femoral-popliteal occlusive atherosclerotic disease (MORPHEAS) database was queried. The MORPHEAS investigators included experienced providers at four centers who previously had not utilized rotational atherectomy. The primary endpoint was flow-limiting dissection and/or >50% recoil resulting in stent-placement while a secondary endpoint included peripheral thromboembolism incidence. Results: One hundred thirteen patients were enrolled. Only femoropopliteal occlusions were included in the analysis and anatomic distribution and calcification severity were depicted separately. The most common adjunctive therapy was drug-coated balloon angioplasty (84%; N.=96). Flow-limiting dissection was identified in 16% (N.=18) and thromboembolism occurred in 4% (N.=4). Diabetes increased risk of thromboembolism (P=0.03) while lesion length ≥8.0 cm (P=0.07) and SFA-popliteal adductor canal location (P=0.01) were associated with flow-limiting dissection. In multivariable analysis, SFA-popliteal adductor canal occlusion had a 4.7-fold risk of perioperative complications (OR=4.7, 95%CI: 1.1-21.0; P=0.04). Conclusions: Rotational atherectomy was characterized by reproducible performance among four centers; however, diabetic patients, as well as those with long-segment, heavily calcified SFA-popliteal adductor canal occlusion present greatest risk of complications.
Databáze:	MEDLINE
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