Document Detail


Safety and efficacy of directional atherectomy for the treatment of in-stent restenosis of the femoropopliteal artery.
MedLine Citation:
PMID:  20671639     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIM: The aim of this study was to evaluate safety and efficacy of directional atherectomy with the Silver HawkTM device as first line treatment for in-stent restenosis of the femoropopliteal artery.
METHODS: Over a period of 1.5 years in-stent restenosis of the femoropopliteal artery in 35 lesions (34 legs, 33 patients) was primarily treated with directional atherectomy. Primary endpoint was treatment success (<50% residual stenosis) and the absence of complications. Secondary endpoint was target lesion patency after 3, 6 and 12 month assessed by duplexsonography.
RESULTS: Mean patient age was 70 years (SD+/-10). 74 % were claudicants (Rutherford 2-3), 26% had CLI (Ruther-ford (4-5). 45% were diabetics, 82% had a history of arterial hypertension and nicotine abuse. Mean lesion length was 108 mm (SD+/-102 mm). Treatment success with atherectomy alone was achieved in 86% with additional PTA (43%) success increased to 97%. Adjunctive stent implantation was necessary in 11% of the cases. Post interventional ABI increased from 0.54 (+/-0.26) to 0.77 (+/-0.26). The rate of minor complication was 3% (1/34) and the rate of major complication was 18% (6/34), mainly due to distal embolization. Target lesion patency at 3 month was 86.2%, at 6 month 68% and at 12 month 25%.
CONCLUSIONS: Although atherectomy of in-stent restenosis as a first line treatment yields a high initial success rate with a low requirement for adjunctive PTA and stent implantation, long term patency rates are low. In our study the theoretical advantage of avoiding barotauma did not result in prevention of recurrent intimal hyperplasia.
Authors:
J Trentmann; N Charalambous; M Djawanscher; J -P Schäfer; T Jahnke
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of cardiovascular surgery     Volume:  51     ISSN:  0021-9509     ISO Abbreviation:  J Cardiovasc Surg (Torino)     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-30     Completed Date:  2010-12-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0066127     Medline TA:  J Cardiovasc Surg (Torino)     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  551-60     Citation Subset:  IM    
Affiliation:
Clinic for Diagnostic Radiology, Schleswig Holstein University Clinic, Kiel Campus, Kiel, Germany. j.trentmann@rad.uni-kiel.de
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Angioplasty, Balloon / adverse effects,  instrumentation*
Arterial Occlusive Diseases / diagnosis,  therapy*
Atherectomy* / adverse effects,  instrumentation
Constriction, Pathologic
Female
Femoral Artery* / radiography,  ultrasonography
Germany
Humans
Male
Middle Aged
Popliteal Artery* / radiography,  ultrasonography
Prospective Studies
Recurrence
Stents*
Time Factors
Treatment Outcome
Ultrasonography, Doppler, Duplex
Vascular Patency

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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