| Plaque excision with the Silverhawk catheter: early results in patients with claudication or critical limb ischemia. | |
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MedLine Citation:
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PMID: 17210379 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: This study was conducted to detail the early experience after infrainguinal atherectomy using the Silverhawk plaque excision catheter for the treatment of symptomatic peripheral vascular disease. METHODS: A prospective database was established in August 2004 in which data for operations, outcomes, and follow-up were recorded for patients undergoing percutaneous plaque excision for peripheral arterial occlusive disease. Society for Vascular Surgery (SVS) ischemia scores and femoropopliteal TransAtlantic Inter-Society Consensus (TASC) criteria were assigned. A follow-up protocol included duplex ultrasound surveillance at 1, 3, and 6 months and then yearly thereafter. Standard statistical analyses were performed. RESULTS: During a 17-month period, 66 limbs of 60 patients (37 men [61.7%]) underwent 70 plaque excisions (four repeat procedures). Indications included tissue loss based on SVS ischemia at grades 5 and 6 (25/70), rest pain at grade 4 (22/70), and claudication at grades 2 to 3 (23/70). The mean lesion length was 8.8 +/- 0.7 cm. The technical success rate was 87.1% (61/70). Adjunctive treatment was required in 17 procedures (24.3%), consisting of 14 balloon angioplasties and three stents. Femoropopliteal TASC criteria included 5 TASC A lesions, 14 TASC B lesions, 32 TASC C lesions, and 19 TASC D lesions. Although 17 plaque excisions included a tibial vessel, no patient underwent isolated tibial atherectomy. The mean increase in ankle-brachial index was 0.27 +/- 0.04 and in toe pressure, 20.3 +/- 6.9 mm Hg. Mean duplex ultrasound follow-up was 5.2 months (range, 1 to 17 months). One-year primary, primary assisted, and secondary patency was 61.7%, 64.1%, and 76.4%, respectively. Restenosis or occlusion developed in 12 patients (16.7%) and was detected at a mean of 2.8 +/- 0.7 months. Restenosis or occlusion was significantly more common (P < .05) in patients with TASC C and D lesions compared with patients with TASC A and B lesions. Six (8.3%) of 12 patients underwent reintervention on the basis of duplex ultrasound surveillance results. Four (33.3%) of 12 patients experienced reocclusion during the same hospitalization, and amputation and open revascularization were required in two patients each. CONCLUSIONS: Percutaneous plaque excision is a viable treatment option for lower extremity revascularization. Outcomes are related to ischemia and lesion severity. Patency and limb salvage rates are equivalent to other endovascular modalities. |
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Authors:
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W Brent Keeling; Murray L Shames; Patrick A Stone; Paul A Armstrong; Brad L Johnson; Martin R Back; Dennis F Bandyk |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of vascular surgery Volume: 45 ISSN: 0741-5214 ISO Abbreviation: J. Vasc. Surg. Publication Date: 2007 Jan |
Date Detail:
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Created Date: 2007-01-09 Completed Date: 2007-02-08 Revised Date: 2012-10-03 |
Medline Journal Info:
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Nlm Unique ID: 8407742 Medline TA: J Vasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 25-31 Citation Subset: IM |
Affiliation:
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Division of Vascular and Endovascular Surgery, University of South Florida,Tampa, FL, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Catheterization, Peripheral
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instrumentation* Equipment Design Female Femoral Artery / surgery*, ultrasonography Follow-Up Studies Humans Intermittent Claudication / surgery*, ultrasonography Ischemia / surgery*, ultrasonography Leg / blood supply* Male Popliteal Artery / surgery*, ultrasonography Prospective Studies Severity of Illness Index Treatment Outcome Ultrasonography, Doppler, Duplex Vascular Surgical Procedures / methods* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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