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Early Results of Percutaneous Infrainguinal Atherectomy in Patients With Claudication and Critical Limb Ischemia

OBJECTIVES: Percutaneous infrainguinal atherectomy (PIA) is a new, minimally invasive procedure for the treatment of peripheral arterial disease. PIA has many potential advantages over traditional open surgery, including less procedural morbidity and shorter hospital stays. This study reviews the early results of PIA for the treatment of claudication and limb threatening ischemia.
METHODS: All patients undergoing PIA using the Silverhawk atherectomy catheter at the Jackson Veterans Affairs Medical Center between August 2005 and March 2007 were retrospectively reviewed. Trans-Atlantic Inter-Society Consensus (TASC) scores were assigned to the lesions by review of pre-procedural imaging including magnetic resonance angiography and arteriography. Duplex ultrasound and noninvasive pressure measurements were performed pre-procedure, immediately post-procedure, and 6 months following the procedure.
RESULTS: A total of 57 PIA procedures were performed on 54 limbs in 44 patients during the study period. Indications for intervention were claudication in 28 of 57 (49%) cases, rest pain in 11 of 57 cases (19%), and tissue loss in 18 of 57 (31%) cases. The lesions fell into the following TASC categories: TASC A - 3 (5%), TASC B - 9 (16%), TASC C - 25 (44%), and TASC D - 20 (35%). Adjunctive treatments at the time of intervention included: 8 angioplasties without stent placement and 4 angioplasties with stent placements. Restenosis or reocclusion requiring repeat intervention occurred in 5 patients. Four of 29 patients (14%) with critical limb ischemia ultimately required major amputation, while 25 of 29 patients (86%) had wound healing and resolution of their symptoms. The mean pre-procedure, immediate post-procedure, and 6 month post-procedure ABI measurements were 0.52, 0.72, and 0.65 respectively. All patients with claudication had early improvement of their symptoms.
CONCLUSIONS: PIA is an acceptable treatment option in patients with limb threatening ischemia, resulting in a high rate of limb salvage. Patients with claudication treated with PIA have significant early improvement in their symptoms. The long-term patency of the procedure is not known and requires further study.