Effectiveness and safety of atherectomy versus plain balloon angioplasty for limb salvage in tibioperoneal arterial disease


Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers


Purpose: To evaluate the effectiveness and safety of atherectomy versus plain balloon angioplasty (POBA) for treatment of critical limb ischemia (CLI) due to tibioperoneal arterial disease (TPAD).

Materials and methods: Patients enrolled in the Vascular Quality Initiative registry who had CLI (Rutherford class 4-6) and underwent atherectomy versus POBA alone for isolated TPAD were retrospectively identified. Of eligible patients, a cohort of 2,908 patients was propensity matched 1:1 by clinical and angiographic characteristics. The atherectomy group comprised 1,454 patients with 2,183 arteries treated, the POBA group 1,454 patients with 2,141 arteries treated. The primary study endpoint was major ipsilateral limb amputation. Secondary endpoints were minor ipsilateral amputations, any ipsilateral amputation, primary patency, target vessel revascularization (TVR), and wound healing at 12 months.

Results: Median follow-up was 507 days, mean patient age was 69±11.7 years, and mean occluded length was 6.9±6.5 cm. There was a trend toward higher technical success rates with atherectomy than POBA (92.9% vs. 91.0%, respectively; P=0.06). Rates of major complications during the procedure were not significantly different. The 12-month major amputation rate was similar in the atherectomy and POBA groups (4.5% vs. 4.6%, respectively, P=0.92, OR 0.97, 95% CI 0.68-1.37). There was no difference in 12-month TVR (17.9% vs 17.8% P=0.97) or primary patency (56.4% vs 54.5% P=0.64) between the atherectomy and POBA groups.

Conclusion: In a large, national registry, treatment of TPAD for CLI using atherectomy vs POBA showed no significant differences in procedural complications, major amputations, TVR, or vessel patency at 12 months.



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