Toz Hasan, Kuserli Yusuf, Türkyılmaz Gülsüm, Türkyılmaz Saygın, Kavala Ali Aycan
Department of Cardiovascular Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
Vascular. 2024 Aug 16:17085381241275801. doi: 10.1177/17085381241275801.
This study aims to elucidate the differences in vessel patency rates, procedural complications, and the need for repeat interventions between these two techniques, thereby providing insights into the optimal atherectomy strategy for managing peripheral arterial disease in the femoropopliteal segment. This retrospective study investigated the long-term effectiveness of two atherectomy techniques, rotational atherectomy (RA) and directional atherectomy (DA), in treating lower extremity peripheral artery disease (LE-PAD) affecting the superficial femoral artery (SFA) and popliteal arteries. A total of 134 patients with symptomatic LE-PAD and significant stenosis (70%-99%) were included and divided into two groups based on the atherectomy method used. Both groups underwent similar pre- and post-atherectomy procedures, including drug-coated balloon angioplasty. The primary outcome measure was clinical success, defined as procedural success and an improvement in Rutherford classification at 1 year. Baseline characteristics were similar between the two groups, with no significant differences in demographics or lesion characteristics, except for a higher proportion of right-sided lesions in the DA group. While both RA and DA effectively improved ankle-brachial index (ABI) and Rutherford classification at 12 months, RA demonstrated superior long-term benefits, with significantly higher ABI at 24 months and a greater proportion of asymptomatic patients. Although RA had a longer procedural duration and a higher incidence of dissection, it resulted in lower residual stenosis and fewer cases of treated segment thrombosis than DA. Both RA and DA are effective treatment options for femoropopliteal lesions, but RA may offer advantages in long-term symptom management and vessel patency. Both rotational and directional atherectomy effectively treat femoropopliteal lesions, with rotational atherectomy demonstrating superior long-term outcomes in terms of symptom management and vessel patency. Despite longer procedural times and a slightly higher risk of dissection, rotational atherectomy resulted in lower residual stenosis and fewer cases of treated segment thrombosis than directional atherectomy.
本研究旨在阐明这两种技术在血管通畅率、手术并发症以及重复干预需求方面的差异，从而为股腘段外周动脉疾病的最佳旋切策略提供见解。这项回顾性研究调查了两种旋切技术，即旋磨术（RA）和定向旋切术（DA），在治疗累及股浅动脉（SFA）和腘动脉的下肢外周动脉疾病（LE-PAD）中的长期有效性。总共纳入了134例有症状的LE-PAD且存在严重狭窄（70%-99%）的患者，并根据所使用的旋切方法将其分为两组。两组在旋切术前和术后均接受了类似的程序，包括药物涂层球囊血管成形术。主要结局指标为临床成功，定义为手术成功且1年后卢瑟福分类有所改善。两组的基线特征相似，在人口统计学或病变特征方面无显著差异，但DA组右侧病变的比例更高。虽然RA和DA在12个月时均有效改善了踝肱指数（ABI）和卢瑟福分类，但RA显示出更好的长期效益，在24个月时ABI显著更高，无症状患者的比例也更大。尽管RA的手术时间更长且夹层发生率更高，但与DA相比，它导致的残余狭窄更低，治疗节段血栓形成的病例更少。RA和DA都是股腘段病变的有效治疗选择，但RA在长期症状管理和血管通畅方面可能具有优势。旋磨术和定向旋切术均能有效治疗股腘段病变，在症状管理和血管通畅方面，旋磨术显示出更好的长期结局。尽管手术时间更长且夹层风险略高，但旋磨术导致的残余狭窄比定向旋切术更低，治疗节段血栓形成的病例也更少。
