Werner-Gibbings Keagan, Dubenec Steven
Department of Vascular Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
ANZ J Surg. 2017 Jun;87(6):E1-E4. doi: 10.1111/ans.12897. Epub 2014 Nov 3.
Endovascular interventions are increasingly utilized in managing occlusive peripheral vascular disease. Angioplasty and stenting remain the mainstay of endovascular management; however, newer treatment modalities such as excisional atherectomy provide the clinician with additional treatment options. While demonstrating promising results in available trials, a paucity of data exist regarding peripheral atherectomy. The purpose of this retrospective clinical study was to assess the efficacy and safety of excisional atherectomy with the TurboHawk atherectomy device (Covidien/ev3, Plymouth, MN, USA) in the treatment of lower limb peripheral vascular disease and to evaluate the learning curve involved in the institution of a new treatment modality.
A retrospective analysis was performed on all patients undergoing atherectomy for symptomatic lower limb peripheral vascular disease by a single clinician between November 2011 and June 2013. Forty-seven vessels on 28 legs in 24 patients were treated during the period.
Atherectomy was possible in 98% of cases. The 6- and 12-month primary patency was 72.6 and 58.9%, respectively. The primary-assisted patency was 93.2% at 6 months and 74.6% at 12 months. There were significantly greater patency rates in the TransAtlantic Inter-Society Consensus A + B lesions and a non-significant trend towards improved patency rates in claudicants versus critical limb ischaemia. There were four instances of embolization and four cases of dissection.
Excisional atherectomy provides a further option for the minimally invasive management of peripheral vascular disease. It has similar patency rates to established endovascular therapies and should be considered among the treatment options in patients with favourable pathology.
血管内介入治疗在闭塞性外周血管疾病的管理中应用越来越广泛。血管成形术和支架置入术仍然是血管内治疗的主要手段；然而，诸如斑块旋切术等更新的治疗方式为临床医生提供了更多治疗选择。尽管在现有试验中显示出有前景的结果，但关于外周斑块旋切术的数据却很少。这项回顾性临床研究的目的是评估使用TurboHawk斑块旋切装置（美国明尼苏达州普利茅斯市科维迪恩/ev3公司生产）进行斑块旋切术治疗下肢外周血管疾病的有效性和安全性，并评估引入一种新治疗方式所涉及的学习曲线。
对2011年11月至2013年6月期间由一名临床医生为有症状的下肢外周血管疾病患者进行斑块旋切术的所有患者进行回顾性分析。在此期间，对24例患者28条腿上的47条血管进行了治疗。
98%的病例可以进行斑块旋切术。6个月和12个月时的主要通畅率分别为72.6%和58.9%。主要辅助通畅率在6个月时为93.2%，12个月时为74.6%。跨大西洋跨学会共识A + B级病变的通畅率明显更高，间歇性跛行患者与严重肢体缺血患者相比，通畅率有改善的非显著趋势。有4例发生栓塞，4例出现夹层。
斑块旋切术为外周血管疾病的微创管理提供了另一种选择。它与已确立的血管内治疗方法具有相似的通畅率，对于病理情况有利的患者，应将其纳入治疗选择之中。
