Success of Atherectomy in Lower Extremity Ischemia Performed in Office Based Lab
Objectives: To determine the safety and efficacy of infrainguinal artery atherectomy in office based lab To find the patency difference with or without secondary intervention. To assess patency based on Rutherford class. Methods: In this IRB approved retrospective study, between 2011-2016, 260 patients underwent interventions on 362 limbs and 615 vessels. Orbital atherectomy and Laser atherectomy was performed. Demographic data, Rutherford class, vessels treated, vessel approach, type of device used were tabulated. Success and type of procedure, complications, 30 day major amputations, and deaths were recorded. Technical success was defined as resolution of stenosis < 50%. Restenosis was categorized as 2x increase in velocity at treatment site. Reintervention was performed when the patient became symptomatic and the vessel had restenosis of >50%. In follow-up, treatment area patency was evaluated by both physical exam and ultrasound. Life table analyses were performed and Kaplan Meir curves were created. Results: Patient disease incidence: Smoking(35%), Diabetes(59%), Hypertension(77%), Hyperlipidemia(68%), Renal insufficiency(50%), Dialysis(16%), COPD(20%), CHF(21%), previous procedure on the same vessel(16%), previous bypass(12%). Rutherford class distribution: 2(n=8), 3(n=166), 4(n=41), 5(n=103), 6(n=11). There were 23 major amputations on 362(6%) limbs in Rutherford class 4(3/41), 5(17/103), 6(3/11). Mortality:0. Complications: perforation:3, abrupt closure:2, embolization:1. Technical success: 604/615(98%) vessels. Atherectomy device: Orbital (n=515) with patency of 91%, mean follow up 29(±31) months; Laser (n=100) with patency of 78%, mean follow up 33(±31) months. The difference was not statistically significant. Patency with angioplasty was 89% in 498 vessels, mean follow up 31(±31) months: In 106 vessels treated with angioplasty and stent 86%, mean follow up 23(±29) months. Total patency with or without secondary intervention was 84%, mean follow up 30 (±31) months. 503 vessels not needing secondary intervention had a patency of 90%, mean follow up 29(±31) months. 101 vessels in 57 patients needed secondary intervention because of recurrent stenosis and/or new symptoms with a patency of 67%, mean of 35(±33) months. In follow up, 143 vessels(23.3%) developed >50% stenosis; of those 91(64%) had no reintervention and 52(36%) received reintervention. Patients having reintervention had patency of 67% with mean follow up of 35(±33) months; compared to vessels having no intervention at 96% patency, mean follow up of 30(±28). Patency in different Rutherford class was comparable. Conclusions: In medium term follow up, excellent patency is achieved using atherectomy and angioplasty with minimal complications in an office-based lab. Asymptomatic restenosis of >50% does not warrant reintervention. Procedure has comparable results among various Rutherford classes.