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. 2016 Nov 1:15:42-47.
eCollection 2016 Nov.

Use of the directional atherectomy for the treatment of femoro-popliteal lesions in patients with critical lower limb ischemia

Umberto Marcello Bracale  1 , Gaetano Vitale  2 , Guido Bajardi  3 , Donatella Narese  4 , Ettore Dinoto  3 , Anna Maria Giribono  1 , Doriana Ferrara  1 , Luca Del Guercio  1 , Massimo Midiri  4 , Felice Pecoraro  3
Affiliations

Use of the directional atherectomy for the treatment of femoro-popliteal lesions in patients with critical lower limb ischemia

Umberto Marcello Bracale et al. Transl Med UniSa. .

Abstract

Femoro-popliteal PTA for the treatment of critical limb ischemia is frequently associated with unsatisfactory procedural success rates while directional atherectomy (DCA) has improved success rate since claudicant patients undergoing percutaneous treatment of femoro-popliteal obstructive disease. The aim of this prospective study is to evaluate the safety, efficacy and procedural success of DCA, at one year, in the percutaneous treatment of femoro-popliteal obstructive disease in patients with critical limb ischemia.

Methods: From March 2012 to March 2013 18 consecutive patients with critical limb ischemia were treated with DCA (Turbohawk/Covidien-ev3 Endovascular Inc., North Plymouth, Minnesota, USA) for the treatment of femoro-popliteal obstructive disease. Patients were evaluated at 12 months.

Results: Technical and procedural success was achieved in every patient. No in-hospital major adverse cardiovascular events occurred. Primary endpoint: freedom from any amputation was obtained in all patients. Secondary endpoints: clinical (Rutherford class improvement) and hemodynamic success (Ankle-brachial index improvement) was achieved in all patients.

Conclusion: The use of DCA for the treatment of femoro-popliteal obstructive disease is a safe and effective therapeutic strategy for patients with critical limb ischemia. The data included in our study should be considered hypothesis-generating in order to design of a randomized trial comparison with conventional PTA.

Keywords: Turbohawk device; atherectomy; critical limb ischemia; endovascular treatment.

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Figures

Fig. 1
Fig. 1
Illustration of the Turbohawk™ device. A. Multiple preocclusive SFA stenosis. B. Deployment of distal protection device. C. Plaque excision with Turbohawk™ (description of the technique in the text).
Fig. 2
Fig. 2
A. intraoperative image showing Turbohawk™ device and distal protection filter SpiderFX™. B. Long trimmed plaque.
Fig. 3
Fig. 3
Intraoperative angiogram. A. Superficial femoral and popliteal artery occlusion. B. Femoro-popliteal pre-dilatation. C. Postprocedural result after plaque excision with Turbohawk.
Fig. 4
Fig. 4
Macroscopic embolic material after distal embolic protection filter removal.
See this image and copyright information in PMC

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