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Directional Atherectomy for Treating In-Stent Restenosis of the Superficial Femoral Artery

Vascular Specialist International 2020년 36권 3호 p.136 ~ 143
조성신, 한아람, 안상현, 민상일, 하종원, 제환준, 민승기,
소속 상세정보
조성신 ( Cho Sung-Sin ) - Seoul National University College of Medicine Department of Surgery
한아람 ( Han Ah-Ram ) - Seoul National University College of Medicine Department of Surgery
안상현 ( Ahn Sang-hyun ) - Seoul National University College of Medicine Department of Surgery
민상일 ( Min Sang-Il ) - Seoul National University College of Medicine Department of Surgery
하종원 ( Ha Jong-Won ) - Seoul National University College of Medicine Department of Surgery
제환준 ( Jae Hwan-Jun ) - Seoul National University Hospital Department of Radiology
민승기 ( Min Seung-Kee ) - Seoul National University College of Medicine Department of Surgery

Abstract


Purpose: The optimal treatment for in-stent restenosis (ISR) of the superficial femoral artery (SFA) is still in debate. This study aimed to evaluate the safety and effectiveness of directional atherectomy (DA) as a primary treatment modality for ISR in SFA.

Materials and Methods: A retrospective single-center analysis was conducted. In total, 617 stents were deployed in 242 limbs for SFA diseases during the study period. ISR was identified in 29 limbs (12.0%); 14 limbs were treated with DA and 15 limbs with balloon angioplasty (BAP) alone. Technical success rate, target lesion revascularization (TLR) and patency rates (PRs) at 12 months, and any complications were evaluated.

Results: DA group included complete occlusions in 50% of patients and BAP group included in 40%. Mean improvement in the ankle-brachial index was 0.29 and 0.32, respectively (P=0.638). Technical success was achieved in all patients. The procedural success rates were 85.7% and 73.3%, respectively (P=0.651). There was no significant difference regarding residual stenosis, distal embolization, or flow-limiting dissection. Primary PRs at 1 year were 85.7% and 73.3%, secondary PRs were 100.0% and 93.3%, and TLR rates were 14.3% and 20.0% (P=0.411, 0.326, and 0.684, respectively).

Conclusion: Short-term outcomes after DA for ISR were not different from those after BAP but showed a tendency of better primary PR and TLR. Larger multicenter prospective studies are needed to define the role of DA in ISR treatment.

키워드

Femoral artery; Directional atherectomy; Balloon angioplasty; Vascular patency; Vascular graft restenosis; Stents

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