Peripheral Directional Atherectomy: Arteriographic vs Hemodynamic Assessment of Cumulative Patency

From April, 1990, to April, 1992, peripheral atherectomy using a Simpson AtheroCath was performed in 46 patients (56 limbs) with a total of 106 lesions. There were 100 stenoses (74 eccentric, 26 concentric) and 6 occlusions. Success was achieved in 103/106 (97%) procedures (97 stenoses and 6 occlusions), reducing the lesion to < 35% (stenoses: 81±13% to 22±9%, p < 0.0001, and the occlusions : 100% to 16±8%; p < 0.0001). Ankle/brachial index (ABI) improved from 0.58±0.17 to 0.85 ± 0.22 (p < 0.0001). Clinical success was achieved in 42 patients (91%). Complications occurred in 6 patients (13%): groin hematoma in 5, and in 1, acute occlusion of the femoral artery with distal embolization. There were 13 hemodynamic failures in 11 patients (28%) with an ABI reduction of more than 0.15 with respect to the maximum early postoperative level, over a mean follow-up of 15.1 months. Failure of the procedure was confirmed by arteriography in only 4 cases. Cumulative eighteen-month patency rates were 60% using arteriographic assessment and 44% for hemodynamic assessment (p < 0.025). Patency rates were 56% for the patients with a runoff score ranging between 1 and 5 and 17% with a score > 5 (p < 0.0025). A reduction of ABI during follow-up is not a true indicator of procedural failure, but it correlates with possible progression of distal disease. Evaluation of preoperative runoff may be used as a prognostic indicator.