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In infrapopliteal CLI, atherectomy may lead to more complications
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Among patients with critical limb ischemia requiring interventions in the infrapopliteal arteries, atherectomy with or without angioplasty had similar patency rates vs. angioplasty alone, but was linked with higher reintervention and local complication rates, researchers reported.
Saqib Zia, MD, assistant professor of surgery at Staten Island University Hospital, and colleagues conducted a retrospective, longitudinal, single-center study of 290 patients with CLI (mean age, 67 years; 61% men) who underwent 342 infrapopliteal interventions, either atherectomy with or without angioplasty (46.5%) or angioplasty alone (53.5%).
The primary outcome was primary patency. Other outcomes of interest included reintervention rates, amputation rates, primary-assisted patency, local complications and mortality. Mean follow-up was 19 months in the angioplasty group and 20 months in the atherectomy group.
At 3 months, the rate of primary patency was 91.8% in the angioplasty group vs. 92.5% in the atherectomy group (P = .8), Zia reported at the Society for Vascular Surgery Vascular Annual Meeting.
The primary patency rates mostly remained similar between the groups at 6 months (angioplasty, 86%; atherectomy, 85%; P = .07), 12 months (angioplasty, 85%; atherectomy, 77%; P = .04) and 18 months (angioplasty, 83.1%; atherectomy, 76.1%; P = .08), according to the researchers.
Reinterventions were necessary in 28.3% of the atherectomy group vs. 15.8% of the angioplasty group (P = .058), and median time until reintervention was 74 days.
The only independent predictor of reintervention in both groups was diabetes (beta = 0.76; P = .018), Zia said.
Primary-assisted patency rates were lower in the atherectomy group (86.3% vs. 76.1%; P = .0174) and local complication rates were higher in the atherectomy group (0.5% vs. 4.4%; P = .0273), whereas there was no difference between the groups in 30-day amputation rates (angioplasty, 2.7%; atherectomy, 3.8%; P = .7606) or 30-day mortality rates (angioplasty, 2.2%; atherectomy, 1.3%; P = .6894), according to the researchers.
“Atherectomy provides similar patency rates to angioplasty alone for [infrapopliteal peripheral artery disease] but [is] associated with higher reintervention and local complication rates,” Zia and colleagues wrote in an abstract. “Further appropriately designed studies are required to determine the exact role of atherectomy in this subset of patients.”
“The future perspectives of this continuously evolving endovascular technique should be better defined based on robust data,” Zia told Cardiology Today’s Intervention.
– by Erik Swain
Reference:
Zia S, et al. S3: Scientific Session 3. Presented at: Society for Vascular Surgery Vascular Annual Meeting; June 20-23, 2018; Boston.
Disclosure: Zia reports no relevant financial disclosures.