SilverHawk Plaque Excision Versus Angioplasty for Symptomatic Infrapopliteal Arterial Occlusive Disease_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 GUOJian-ming ,  GUYong-quan , GUOLian-rui , TONGZhu , CUIShi-jun , GAOXi-xiang , MATian-yu , LIYang , ZHANGJian , WANGZhong-gao

Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China;

Corresponding?author：

GUYong-quan, Email: 15901598209@163.com

Keywords：

Plaque excision; Angioplasty; Atherosclerosis obliterans; Infrapopliteal

DOI：

10.7507/1007-9424.20150240

Video：

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Objective To evaluate the safety and efficiency of SilverHawk plaque excision in treatment of sympto-matic infrapopliteal arterial occlusive disease (IPAD). Methods The clinical and follow-up data of 54 consecutive patients with IPAD underwent endovascular treatment from 2011 to 2013 in this hospital were analyzed retrospectively. There were 29 males and 25 females. The age was (65.8±4.5) years, the period was (25.1±3.3) months. All the patients were Fontaine gradeⅡb-Ⅳ. The patients were divided into plaque excision group (n=9) and angioplasty group (n=45) according to the treatment method. The rates of technical success, perioperative complications, limb salvage and reintervention were observed between two groups. Results ①There were no significant differences in the gender, age, complications, ankle brachial index (ABI), outflow tract score, lesion length, and other clinical data between the 2 groups (P > 0.05).②The technical success rate had no significant difference between the plaque excision group and the angioplasty group[100% (9/9) versus 86.7% (39/45), P=0.574]. Six cases were failed because the guide wire could not pass through the diseased segment in 4 cases and there were 2 cases of serious residual stenosis in the angioplasty group.③There was no significant difference in the incidence of vascular complications between the 2 groups[11.1% (1/9) versus 11.1% (5/45), P=1.000].④The follow-up results:One case was received the carotid endarterectomy on 4 months after operation because of severe carotid artery stenosis, the lower limbs had no new onset of symptoms in the plaque excision group. One patient due to myocardial infarction was death on 3 months after operation, 2 patients due to pulmonary infection and heart failure were death on 4 months and 5 months after operation respectively in the angioplasty group. The limb salvage rates and reintervention rates on 6 months and 12 months after operation had no significant differences between the 2 groups (P> 0.05). The ABI and ABI average improvement also had no significant significances between the 2 groups (P > 0.05). Conclusion Plaque excision is a safe and acceptable method to treat symptomatic IPAD, and its efficacy is better than angioplasty.

Citation： GUOJian-ming, GUYong-quan, GUOLian-rui, TONGZhu, CUIShi-jun, GAOXi-xiang, MATian-yu, LIYang, ZHANGJian, WANGZhong-gao. SilverHawk Plaque Excision Versus Angioplasty for Symptomatic Infrapopliteal Arterial Occlusive Disease. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(8): 922-925. doi: 10.7507/1007-9424.20150240 Copy

1.	Rutherford RB, Baker JD, Ernst C, et al. Recommended standards for reports dealing with lower extremity ischemia:Revised version. J Vasc Surg, 1997, 26(3):517-538.
2.	Wolfe JH, Wyatt MG. Critical and subcritical ischaemia. Eur J Vasc Endovasc Surg, 1997, 13(6):578-582.
3.	師天雄, 繆健航, 胡錫祥.下肢動脈硬化性閉塞癥的介入治療體會.中國普外基礎與臨床雜志, 2010, 17(7):676-678.
4.	陸京伯, 劉正軍, 林智琪.下肢動脈硬化性閉塞癥的早期診斷.中國普外基礎與臨床雜志, 2010, 17(7):690-693.
5.	Romiti M, Albers M, Brochado-Neto FC, et al. Meta-analysis of infrapopliteal angioplasty for chronic critical limb ischemia. J Vasc Surg, 2008, 47(5):975-981.
6.	谷涌泉, 張建, 齊立行, 等.小腿動脈球囊成形術治療2型糖尿病下肢缺血的療效觀察.中國糖尿病雜志, 2010, 18(2):132-134.
7.	谷涌泉, 郭連瑞, 郭建明, 等.經腓動脈穿刺雙球囊技術開通股淺動脈全程閉塞導致的嚴重下肢缺血1例報告.中國微創外科雜志, 2014, 20(1):84-85.
8.	谷涌泉, 郭連瑞, 齊立行, 等.膝下動脈支架成形術治療嚴重下肢缺血.中華普通外科雜志, 2012, 27(3):184-186.
9.	Gu YQ, Guo LR, Qi LX, et al. Plaque excision in the management of lower-limb ischemia of atherosclerosis and in-stent restenosis with the SilverHawk atherectomy catheter. Int Angiol, 2013, 32(4):362-367.
10.	Zeller T, Rastan A, Schwarzw?lder U, et al. Midterm results after atherectomy-assisted angioplasty of below-knee arteries with use of the Silverhawk device. J Vasc Interv Radiol, 2004, 15(12):1391-1397.
11.	Rastan A, Krankenberg H, Baumgartner I, et al. Stent placement vs. balloon angioplasty for popliteal artery treatment:two-year results of a prospective, multicenter, randomized trial. J Endovasc Ther, 2015, 22(1):22-27.
12.	Tan TW, Semaan E, Nasr W, et al. Endovascular revascularization of symptomatic infrapopliteal arteriosclerotic occlusive disease:comparison of atherectomy and angioplasty. Int J Angiol, 2011, 20 (1):19-24.
13.	Ramaiah V, Gammon R, Kiesz S, et al. Midterm outcomes from the TALON Registry:treating peripherals with SilverHawk:outcomes collection. J Endovasc Ther, 2006, 13(5):592-602.
14.	Lo RC, Darling J, Bensley RP, et al. Outcomes following infrapopli-teal angioplasty for critical limb ischemia. J Vasc Surg, 2013, 57(6):1455-1463.
15.	Shammas NW, Coiner D, Shammas GA, et al. Percutaneous lower-extremity arterial interventions with primary balloon angioplasty versus Silverhawk atherectomy and adjunctive balloon angioplasty:randomized trial. J Vasc Interv Radiol, 2011, 22(9):1223-1228.

1. Rutherford RB, Baker JD, Ernst C, et al. Recommended standards for reports dealing with lower extremity ischemia:Revised version. J Vasc Surg, 1997, 26(3):517-538.
2. Wolfe JH, Wyatt MG. Critical and subcritical ischaemia. Eur J Vasc Endovasc Surg, 1997, 13(6):578-582.
3. 師天雄, 繆健航, 胡錫祥.下肢動脈硬化性閉塞癥的介入治療體會.中國普外基礎與臨床雜志, 2010, 17(7):676-678.
4. 陸京伯, 劉正軍, 林智琪.下肢動脈硬化性閉塞癥的早期診斷.中國普外基礎與臨床雜志, 2010, 17(7):690-693.
5. Romiti M, Albers M, Brochado-Neto FC, et al. Meta-analysis of infrapopliteal angioplasty for chronic critical limb ischemia. J Vasc Surg, 2008, 47(5):975-981.
6. 谷涌泉, 張建, 齊立行, 等.小腿動脈球囊成形術治療2型糖尿病下肢缺血的療效觀察.中國糖尿病雜志, 2010, 18(2):132-134.
7. 谷涌泉, 郭連瑞, 郭建明, 等.經腓動脈穿刺雙球囊技術開通股淺動脈全程閉塞導致的嚴重下肢缺血1例報告.中國微創外科雜志, 2014, 20(1):84-85.
8. 谷涌泉, 郭連瑞, 齊立行, 等.膝下動脈支架成形術治療嚴重下肢缺血.中華普通外科雜志, 2012, 27(3):184-186.
9. Gu YQ, Guo LR, Qi LX, et al. Plaque excision in the management of lower-limb ischemia of atherosclerosis and in-stent restenosis with the SilverHawk atherectomy catheter. Int Angiol, 2013, 32(4):362-367.
10. Zeller T, Rastan A, Schwarzw?lder U, et al. Midterm results after atherectomy-assisted angioplasty of below-knee arteries with use of the Silverhawk device. J Vasc Interv Radiol, 2004, 15(12):1391-1397.
11. Rastan A, Krankenberg H, Baumgartner I, et al. Stent placement vs. balloon angioplasty for popliteal artery treatment:two-year results of a prospective, multicenter, randomized trial. J Endovasc Ther, 2015, 22(1):22-27.
12. Tan TW, Semaan E, Nasr W, et al. Endovascular revascularization of symptomatic infrapopliteal arteriosclerotic occlusive disease:comparison of atherectomy and angioplasty. Int J Angiol, 2011, 20 (1):19-24.
13. Ramaiah V, Gammon R, Kiesz S, et al. Midterm outcomes from the TALON Registry:treating peripherals with SilverHawk:outcomes collection. J Endovasc Ther, 2006, 13(5):592-602.
14. Lo RC, Darling J, Bensley RP, et al. Outcomes following infrapopli-teal angioplasty for critical limb ischemia. J Vasc Surg, 2013, 57(6):1455-1463.
15. Shammas NW, Coiner D, Shammas GA, et al. Percutaneous lower-extremity arterial interventions with primary balloon angioplasty versus Silverhawk atherectomy and adjunctive balloon angioplasty:randomized trial. J Vasc Interv Radiol, 2011, 22(9):1223-1228.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

SilverHawk Plaque Excision Versus Angioplasty for Symptomatic Infrapopliteal Arterial Occlusive Disease

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