Original Title: One-Year Outcomes Following Directional Atherectomy of Infrapopliteal Lesions: Subgroup Results of the Prospective, Multicenter DEFINITIVE LE Trial. Reference: Aljoscha Rastan, et al Journal Endovascular Therapy 2015;22:839-846

Courtesy of Dr. Carlos Fava

Infrapopliteal peripheral vascular disease continues to rise, especially in patients with diabetes and kidney failure, usually presenting diffuse and fairly calcified lesions. Removing the atherosclerotic burden could be a successful strategy.

This study included 145 patients undergoing directional atherectomy for below the knee (BTK) disease with SilverHawk/TurboHawk devices.
Half the population presented critical limb ischemia (CLI) with a 68% diabetes rate. Average lesion length was 6 cm and 15% presented ≥10 cm lesions.

Most patients received the SilverHawk, which required 10% predilation, and had 70% device success (residual lesion ≤30%). No stent or drug eluting balloon was used. Procedural success was reached in 84% of lesions, with no differences between those presenting intermittent claudication and CLI.
At one year, primary patency was 84% and secondary, 92%. Freedom from clinical driven target lesion revascularization was 91%.

Limb salvage was 94% in those with CLI and 100% in those with intermittent claudication. Age and kidney failure were restenosis predictors.
At one year, there were significant improvements in Rutherford category and objective measures of walking distance and quality of life.

Conclusion
This study shows that directional atherectomy in infrapopliteal lesions has promising technical and clinical results for patients with critical limb ischemia or intermittent claudication.

Editorial Comment
Infrapopliteal PCI is challenging due to the complexity of lesions. This modern prospective study shows that directional atherectomy is a sensible strategy to follow, given its favorable 12 month results.

Courtesy of Dr. Carlos Fava
Interventional Cardiologist
Favaloro Foundation – Buenos Aires