In-Hospital Outcomes of Atherectomy During Endovascular Lower Extremity Revascularization

Panaich, Sidakpal; Arora, Shilpkumar; Patel, Nilay; Patel, Nileshkumar; Patel, Samir; Savani, Chirag; Singh, Vikas; Jhamnani, Sunny; Sonani, Rajesh; Lahewala, Sopan; Thakkar, Badal; Patel, Achint; Dave, Abhishek; Shah, Harshil; Bhatt, Parth; Jaiswal, Radhika; Ghatak, Abhijit; Gupta, Vishal; Deshmukh, Abhishek; Kondur, Ashok; Schreiber, Theodore; Grines, Cindy L.; Badheka, Apurva

doi:10.1016/j.amjcard.2015.11.025

Cited by 22 publications

(15 citation statements)

References 19 publications

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“…Therefore, it is safe to assume that as the prevalence of PAD-CLI increases, the need for revascularization will continue to grow. A recent HCUP-based study found that atherectomy use in conjunction with angioplasty (with or without stenting) was associated with improved in-hospital outcomes including lower amputation rates, mortality and postprocedural complications [49]. New atherectomy technologies like OAS hold the possibility of improving safety and outcomes while controlling costs.…”

Section: Discussionmentioning

confidence: 99%

Hospital cost impact of orbital atherectomy with angioplasty for critical limb ischemia treatment: a modeling approach

et al. 2018

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Aim:The incremental cost of peripheral orbital atherectomy system (OAS) plus balloon angioplasty (BA) versus BA-only for critical limb ischemia was estimated. Materials & methods: A deterministic simulation model used clinical and healthcare utilization data from the CALCIUM 360• trial and current cost data. Incremental cost of OAS + BA versus BA-only included differential utilization during the procedure and adverse-event costs at 3, 6 and 12-months. Results: For every 100 procedures, incremental annual costs to the hospital were US$350,930 lower with OAS + BA compared with BA-only. Despite higher upfront costs, savings were realized due to reduced need for revascularization, amputation and end-of-life care over 6-12-month postoperative period. Conclusion: Atherectomy with OAS prior to BA was associated with cost savings to the hospital. Critical limb ischemia (CLI) is the most serious manifestation of peripheral artery disease (PAD). Considered as the 'end stage' of PAD, it involves a chronic lack of blood supply leading to persistent ischemic rest pain in the feet or toes, nonhealing wounds and ulcers, and gangrene [1]. CLI often results in amputation of the affected limb(s) with roughly 25% of CLI patients receiving at least one lower extremity amputation [2]. The economic burden of CLI-diagnosed Medicare patients exceeds US$3.1 billion annually, with most of this cost reflecting the high incidence of hospitalizations related to limb loss and the need for major amputation [3].Treating CLI patients has remained quite challenging, since the associated calcification requires a unique mechanism of action to treat the lesion without damaging the vessel [4]. Balloon angioplasty (BA) continues to be the first-line of revascularization strategy in patients where procedural success via less invasive, nonsurgical approach is favored despite consistently poor intermediate and long-term patency outcomes [5,6]. The latter has been attributed to the presence of calcified plaque in femoropopliteal lesions, with arterial wall calcium associated with higher rates of procedural complications, and flow-limiting dissections that frequently require stent deployment in order to maintain vessel patency [4][5][6]. Furthermore, restenosis rates as high as 40-60% within 1 year of postprocedure and poor correlation between primary patency and limb preservation have been reported. But the American College of Cardiology/American Heart Association guidelines currently recommend against primary stenting of femoropopliteal lesions with atherectomy and stent devices indicated for 'bailout' purposes following suboptimal BA results [5]. Stenting in calcified segments after a prior failed BA often results in stent under expansion and malapposition [6,7]. These are recognized predictors of long-term stent patency and indicate an increased risk of

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Section: Discussionmentioning

confidence: 99%

Hospital cost impact of orbital atherectomy with angioplasty for critical limb ischemia treatment: a modeling approach

et al. 2018

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“…Atherectomy appears adjunctively important to debulk plaque within vessels, especially heavily calcified plaques. 43 The role of atherectomy is evolving, with the devices, techniques and experience constantly growing. While successfully debulking lesions, 43,44 atherectomy is insufficient alone to revascularize lesions.…”

Section: Atherectomy To Debulk the Lesionmentioning

confidence: 99%

“…43 The role of atherectomy is evolving, with the devices, techniques and experience constantly growing. While successfully debulking lesions, 43,44 atherectomy is insufficient alone to revascularize lesions. 43 Further data with suitable control arms will be required to clarify its comparative efficacy as an adjunct to modify the lesion in preparation for balloon angioplasty and/or stenting.…”

Section: Atherectomy To Debulk the Lesionmentioning

confidence: 99%

“…Patency rates vary widely with their use, ranging between 54-93%. [43][44][45][46][47][48][49][50] Directional atherectomy devices utilize a cutting device along the longitudinal plane of the vessel. These devices vary in the size and number of blades, and are limited by relatively high rates of distal embolization, 47 leading many experts to recommend distal embolization protection devices, such as the Spyder FX™ (Ev3, Irvine, CA) with their use.…”

Section: Atherectomy To Debulk the Lesionmentioning

confidence: 99%

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Endovascular Devices and Revascularization Techniques for Limb-Threatening Ischemia in Individuals With Diabetes

Chung

2017

J Diabetes Sci Technol

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Diabetes mellitus (DM) is a rapidly worsening global epidemic over the last thirty-five years. The increased prevalence of DM has changed the phenotypic expression of atherosclerotic limb threatening ischemia (LTI), resulting in an increase in lesions in the tibial vessels. These patients are also afflicted with peripheral neuropathy, foot deformities, and medial calcification of the vasculature. In response to the evolving phenotype of atherosclerosis, newer minimally invasive tools and techniques have been developed to improve the blood supply in LTI. Arterial access, traditionally obtained from the contralateral common femoral artery (CFA) in a retrograde fashion, is now also frequently being obtained in the ipsilateral limb in an antegrade fashion. Retrograde access of the tibial, pedal, tarsal, or calf collateral vessels is also being utilized to provide a route through which wires, catheters, balloons and stents may be placed. Wires have evolved to have a variety of diameters, materials and coatings providing interventionalists with a wide variety of choices when attempting to traverse blockages in the arteries. When catheters and wires fail to traverse the lesion, newer chronic total occlusion (CTO) devices have been developed to aid in the placement of a wire across the offending lesions. Due to medial calcification associated with DM, atherectomy devices have been developed to debulk the atherosclerotic plaque within the vessel. High pressure balloon angioplasty with or without stents remain the mainstay of intervention, with drug-coated balloons (DCBs) and drug-eluting stents (DESs) now being frequently used to prevent reocclusions of atherosclerotic lesions.

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“…One study using the Nationwide Inpatient Sample from 2012 demonstrated a 10.9% complication rate of peripheral atherectomy. [2] No analysis was performed of factors that increased the risk of an atherectomy-associated complication. In addition, by virtue of the administrative data used, the study only included hospitalized patients and utilized billing codes as surrogates for complications.…”

Section: Introductionmentioning

confidence: 99%

Atherectomy-Associated Complications in the Southern California Vascular Outcomes Improvement Collaborative

Azar

DeRubertis

Baril

et al. 2018

Annals of Vascular Surgery

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In-Hospital Outcomes of Atherectomy During Endovascular Lower Extremity Revascularization

Cited by 22 publications

References 19 publications

Hospital cost impact of orbital atherectomy with angioplasty for critical limb ischemia treatment: a modeling approach

Hospital cost impact of orbital atherectomy with angioplasty for critical limb ischemia treatment: a modeling approach

Endovascular Devices and Revascularization Techniques for Limb-Threatening Ischemia in Individuals With Diabetes

Atherectomy-Associated Complications in the Southern California Vascular Outcomes Improvement Collaborative

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