Three-Year Outcomes of Orbital Atherectomy for the Endovascular Treatment of Infrainguinal Claudication or Chronic Limb-Threatening Ischemia

Autor: Stefanos Giannopoulos, Eric A. Secemsky, Robert Beasley, George L. Adams, Jihad Mustapha, George Pliagas, Ehrin J. Armstrong
Rok vydání: 2020
Předmět:
Male
Time Factors
Atherectomy
medicine.medical_treatment
Iliac Artery and Lower Limb Interventions
Ischemia
Risk Factors
balloon angioplasty
Popliteal Artery
Prospective Studies
femoropopliteal segment
Aged
80 and over
Mortality rate
Middle Aged
infrapopliteal arteries
Limb Salvage
Femoral Artery
Treatment Outcome
Female
Stents
medicine.symptom
Cardiology and Cardiovascular Medicine
critical limb ischemia
medicine.medical_specialty
peripheral artery disease
Lower risk
Amputation
Surgical
Peripheral Arterial Disease
amputation
Angioplasty
medicine
Humans
Radiology
Nuclear Medicine and imaging
Vascular Patency
Aged
business.industry
Stent
Critical limb ischemia
Intermittent Claudication
orbital atherectomy
medicine.disease
mortality
United States
Surgery
Amputation
Chronic Disease
stent
endovascular treatment/therapy
business
Claudication
Angioplasty
Balloon
Zdroj: Journal of Endovascular Therapy
ISSN: 1545-1550
1526-6028
DOI: 10.1177/1526602820935611
Popis: Purpose: To investigate the outcomes of orbital atherectomy (OA) for the treatment of patients with peripheral artery disease (PAD) manifesting as claudication or chronic limb-threatening ischemia (CLTI). Materials and Methods: The database from the LIBERTY study ( ClinicalTrials.gov identifier NCT01855412) was interrogated to identify 503 PAD patients treated with any commercially available endovascular devices and adjunctive OA for 617 femoropopliteal and/or infrapopliteal lesions. Cox regression analyses were employed to examine the association between baseline Rutherford category (RC) stratified as RC 2-3 (n=214), RC 4-5 (n=233), or RC 6 (n=56) and all-cause mortality, target vessel revascularization (TVR), major amputation, major adverse event (MAE), and major amputation/death at up to 3 years of follow-up. The mean lesion lengths were 78.7±73.7, 131.4±119.0, and 95.2±83.9 mm, respectively, for the 3 groups. Results: After OA, balloon angioplasty was used in >98% of cases, with bailout stenting necessary in 2.0%, 2.8%, and 0% of the RC groups, respectively. A small proportion (10.8%) of patients developed angiographic complications, without differences based on presentation. During the 3-year follow-up, claudicants were at lower risk for MAE, death, and major amputation/death than patients with CLTI. The 3-year Kaplan-Meier survival estimates were 84.6% for the RC 2-3 group, 76.2% for the RC 4-5 group, and 63.7% for the RC 6 group. The 3-year freedom from major amputation was estimated as 100%, 95.3%, and 88.6%, respectively. Among CLTI patients only, the RC at baseline was correlated with the combined outcome of major amputation/death, whereas RC classification did not affect TVR, MAE, major amputation, or death rates. Conclusion: Peripheral artery angioplasty with adjunctive OA in patients with CLTI or claudication is safe and associated with low major amputation rates after 3 years of follow-up. These results demonstrate the utility of OA for patients across the spectrum of PAD.
Databáze: OpenAIRE
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