Ann Surg Treat Res.  2017 Jan;92(1):42-46. 10.4174/astr.2017.92.1.42.

Usefulness of intraopertive ultrasonography during directional atherectomy using SilverHawk/TurboHawk system

• Park YS
• Heo SH
• Hyun DH
• Do YS
• Park HS
• Park KB
• Kim YW
• Park YJ
• Lee CH
• Kim DI

• KMID: 2364713
• DOI: http://doi.org/10.4174/astr.2017.92.1.42

Abstract

PURPOSE
Directional atherectomy (DA) was introduced for the management of infrainguinal arterial stenosis or occlusive lesions. The procedure success rate in the DEFINITIVE LE study was determined using radiologic imaging. The aim of our study was to determine the usefulness of intraoperative ultrasonography (USG) during DA for evaluating the early results of this procedure.
METHODS
Patients who underwent DA from January to December 2014 were reviewed retrospectively. Twenty lesions from 14 patients with femoral artery stenosis (>70% stenosis) with short segment occlusive lesions (<2 cm in length) were treated. Among 20 lesions, 3 were treated with the TurboHawk system with a protective device due to lesion calcification. The percentage of stenosis during and after DA was determined with USG.
RESULTS
Median follow-up was 5.1 months, and the procedural success rate (<30% stenosis at the end of the procedure) was 100% on angiography, but only 30% on intraoperative USG. On USG, median residual stenosis was 40% (range, 28%-42%) at the end of DA, 40% (range, 30%-55%) at 1 month, 55% (range, 35%-85%) at 6 months, and 64% (range, 60%-100%) at 1 year. There was one dissection, but no cases of perforation, pseudoaneurysm, or thrombosis. Primary patency, which was defined as a peak systolic velocity ratio ≤3.5 with no reintervention at 6 months, was found in 18 lesions (90%), and 11 of 14 patients (78.6%) were free of ischemic symptoms such as claudication at 6 months.
CONCLUSION
Our results demonstrated that DA with intraoperative USG is an effective treatment option for short segment occlusive lesions of the femoral artery.

Keyword

Silverhawk; Turbohawk; Atherectomy; Ultrasonography

MeSH Terms

Aneurysm, False
Angiography
Atherectomy*
Constriction, Pathologic
Femoral Artery
Follow-Up Studies
Humans
Protective Devices
Retrospective Studies
Thrombosis
Ultrasonography*

Figure

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  Fig. 1 Evaluation of residual luminal stenosis at the end of procedure and specimen of directional atherectomy. Arrow indicated the lesion of directional atherectomy.

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  Fig. 2 Box and whisker plot showing distributions of restenosis (%) during the follow-up periods. The boxes represent the 25th to 75th percentiles, and horizontal lines within the box represent median values. The whiskers represent the lowest and highest values of all of the data, respectively. The stenosis was determined using ultrasonography.

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