Botero-Mora Ana M, Anaya-Martínez Marlon, Ramírez-Herrán William, Botero-Mora Lina M, Arismendi-Ortiz Iván R, Ardila Carlos M
Department of Vascular Surgery, Fundación Santa Fe de Bogotá, Bogotá, COL.
Department of Vascular Surgery, Universidad de Antioquia, Medellín, COL.
Cureus. 2024 Oct 4;16(10):e70840. doi: 10.7759/cureus.70840. eCollection 2024 Oct.
Chronic arterial obstructive disease of the lower limbs is a significant global health issue. Directional atherectomy offers advantages in treating critical ischemia. The objective of this study is to determine the clinical outcomes of patients with critical ischemia who underwent directional atherectomy using the TurboHawkdevice.
A retrospective review was conducted at Alma Mater Hospital in Medellín, Colombia, on all medical records of patients with critical limb ischemia (Rutherford Classes V and VI) who underwent directional atherectomy for infra-inguinal arterial disease.
A total of 42 atherectomies were performed in 41 patients, with 61% classified as Rutherford V and 24.4% as Rutherford VI. The average lesion length to be treated was 60 mm. Calcifications were found in 45.2% of cases, and predilatation angioplasty was used in 42.9% of cases. Atherectomy sites included femoropopliteal segment (40%), superficial femoral (29%), infrapopliteal vessels (14.2%), and more than one vessel in 50% of cases. Technical success was achieved in 78.6% of cases and procedural success in 97.6%, and the need for adjunctive conventional balloon angioplasty was 21.4%, while drug-coated balloon angioplasties were performed in 50% of limbs. The overall complication rate was 14.4%, with embolism at 4.8%, dissection at 4.8%, puncture at 2.4%, and perforation at 2.4%. The average follow-up duration was 12 months, and major amputations were required in 23.8% of cases. Improvement in ankle-brachial index to ≥0.1 was seen in 77% of limbs. Limb survival at 30 days was 85%, and at 90 days, it was 83%. The overall survival rate in the study was 79%.
Directional atherectomy is a safe alternative for managing critical ischemia in Rutherford V and VI patients.
下肢慢性动脉阻塞性疾病是一个重大的全球健康问题。定向斑块旋切术在治疗严重肢体缺血方面具有优势。本研究的目的是确定使用TurboHawk设备进行定向斑块旋切术的严重肢体缺血患者的临床结局。
在哥伦比亚麦德林的母校医院对所有因腹股沟下动脉疾病接受定向斑块旋切术的严重肢体缺血（卢瑟福分级V级和VI级）患者的病历进行回顾性研究。
41例患者共进行了42次斑块旋切术，其中61%为卢瑟福V级，24.4%为卢瑟福VI级。待治疗的平均病变长度为60毫米。45.2%的病例发现钙化，42.9%的病例使用了预扩张血管成形术。斑块旋切部位包括股腘段（40%）、股浅动脉（29%）、腘下血管（14.2%），50%的病例涉及不止一处血管。78.6%的病例技术成功，97.6%的病例手术成功，辅助常规球囊血管成形术的需求为21.4%，而50%的肢体进行了药物涂层球囊血管成形术。总体并发症发生率为14.4%，其中栓塞为4.8%，夹层为4.8%，穿刺为2.4%，穿孔为2.4%。平均随访时间为12个月，23.8%的病例需要进行大截肢。77%的肢体踝肱指数改善至≥0.1。30天时肢体存活率为85%，90天时为83%。该研究的总体生存率为79%。
定向斑块旋切术是治疗卢瑟福V级和VI级患者严重肢体缺血的一种安全选择。
