Short‐term outcomes of excisional atherectomy in lower limb arterial disease

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Excerpt

Peripheral vascular disease (PVD) exerts an increasing burden on the health of the population and the medical system. Symptomatic PVD affects 5% of the population over 601 and is the primary cause of over 25 000 hospitalizations in Australia yearly.2 Historically, open surgical revascularization has been the treatment of choice for lower limb arterial disease;3 however, more recently endovascular therapy, percutaneous transluminal angioplasty (PTA) and stenting, has been employed as first line of therapy in the majority of cases.4
Developments in PVD treatment have provided the clinician with greater diversity in management options. Newer modalities include laser angioplasty,5 drug‐eluting devices,6 brachytherapy7 and excisional atherectomy.8 Excisional atherectomy treats PVD via the use of an intra‐arterial blade to excise atheromatous disease from the vessel wall. Excisional atherectomy first came to prominence in the 1980s; however, initial results that compared poorly with angioplasty led to stagnation in the clinical use of atherectomy.9 Recent developments in atherectomy technology have renewed enthusiasm for this method. The TurboHawk plaque excision system (Covidien/ev3, Plymouth, MN, USA) is a directional, excisional atherectomy catheter approved by the Food and Drug Administration for use in 2011. The catheter utilizes a hub‐based rotating blade situated behind a tapered, debris‐collecting nose cone that can be directed to focus upon specific areas of diseased vessel, maximizing luminal gain while leaving no retained products.
Excisional atherectomy remains a relatively new technology with a lack of data on safety and effectiveness. The aims of this study were twofold: to evaluate excisional atherectomy in infrainguinal PVD in an Australian cohort and to assess the learning curve involved in the application of this new technology in the treatment of PVD.
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