Donas Konstantinos P, Psyllas Anastasios, Pitoulias Apostolos G, Kazemtash Majid, Dahi Firouza, Abu Bakr Nizar, Korosoglou Grigorios
Rhein Main Vascular Center, Department of Vascular and Endovascular Surgery, Asklepios Clinic Langen, Divisions of Vascular Surgery Asklepios Clinics Seligenstadt and Wiesbaden, 63225 Langen, Germany.
Department of Vascular and Endovascular Surgery, Marienhospital Wesel, 46483 Wesel, Germany.
J Clin Med. 2023 Apr 10;12(8):2797. doi: 10.3390/jcm12082797.
Treatment of calcified popliteal artery lesions represents an ongoing challenge for vascular specialists. Biomechanical forces of external compression, torsion and elongation that occur with locomotion in the popliteal segment can lead to stent fractures and occlusions. The aim of our study was to assess the procedural success rate of atherectomy in combination with balloon angioplasty for isolated calcified popliteal artery lesions.
Between January 2020 and December 2022, 62 patients with isolated atherosclerotic lesions of the popliteal artery underwent endovascular treatment by use of rotational atherectomy (Phoenix, Philips USA, (subgroup A) or Jetstream, Boston USA, (subgroup B), atherectomy systems) and additional balloon angioplasty in two vascular centers. The primary outcome measures were: 1. periprocedural clinical and technical success (<30% residual stenosis and no need for bailout stenting due to flow-limiting dissection) and 2. postprocedural increase in the ankle brachial index of more than 0.1.
The overall rate of bailout stenting was 4.8%, whereas the procedural success rate was 98.4%. The rate of procedural complications included 3.7% and 5.7% peripheral embolizations in the subgroups A and B, respectively, and no vessel perforations were noted. All embolizations were successfully treated by catheter aspiration or capture in the pre-treatment placed filter system. In addition, 1 (3.7%) pseudoaneurysm in the groin was reported in subgroup A and treated by surgical means. Median ABI of the affected limbs improved from 0.55 (0.2) to 0.70 (0.2) in subgroup A and from 0.50 (0.2) to 0.95 (0.1) in subgroup B (DABI of 0.15 versus 0.45, < 0.001).
The combination of rotational atherectomy and balloon angioplasty in the popliteal artery showed reproducible outcomes in 2 centers, with low incidence of complications and low rates of bail-out stenting. These findings may contribute to more liberal use of such devices especially in segments with high risk for stent factures and occlusions.
钙化腘动脉病变的治疗一直是血管专科医生面临的挑战。腘动脉段在运动时产生的外部压迫、扭转和拉伸等生物力学力量可导致支架骨折和闭塞。我们研究的目的是评估旋切术联合球囊血管成形术治疗孤立性钙化腘动脉病变的手术成功率。
2020年1月至2022年12月期间，62例患有孤立性腘动脉粥样硬化病变的患者在两个血管中心接受了血管内治疗，使用旋切术（美国飞利浦公司的Phoenix，A组；或美国波士顿公司的Jetstream，B组，旋切系统）并辅以球囊血管成形术。主要观察指标为：1. 围手术期临床和技术成功（残余狭窄<30%且无需因限流性夹层而进行补救性支架置入）；2. 术后踝肱指数增加超过0.1。
补救性支架置入的总体发生率为4.8%，而手术成功率为98.4%。手术并发症发生率包括A组和B组分别为3.7%和5.7%的外周栓塞，未发现血管穿孔。所有栓塞均通过导管抽吸或在预处理时放置的滤器系统捕获成功治疗。此外，A组报告1例（3.7%）腹股沟假性动脉瘤并通过手术治疗。A组患侧肢体的中位踝肱指数从0.55（0.2）改善至0.70（0.2），B组从0.50（0.2）改善至0.95（0.1）（踝肱指数差值分别为0.15和0.45，<0.001）。
旋切术与球囊血管成形术联合用于腘动脉在2个中心显示出可重复的结果，并发症发生率低且补救性支架置入率低。这些发现可能有助于更广泛地使用此类设备，尤其是在支架骨折和闭塞风险较高的节段。
