Application Of Directional Atherectomy Combined With Drug-Coated Balloon In Treatment Of Femoropopliteal Lesions

ObjectiveFemoropopliteal lesions are one of the most common types of peripheral arterial diseases(PAD),seriously affecting the life quality of patients.Drug-coated balloons(DCB)have shown satisfied clinical effect in treatment of femoropopliteal lesions.However,for complex lesions such as severe calcification and chronic total occlusion,the application of DCB alone is still limited owing to elastic recoil and flow-limiting dissection.Directional atherectomy(DA)can remarkably achieve immediate effect of lumen and create good preparation for the application of DCB.The study will explore the effect and safety of DA combined with DCB in the treatment of femoropopliteal lesions,through an analysis of the clinical data of 28 patients.MethodsFrom September 2016 to March 2018,the clinical data of 28 patients with femoropopliteal lesions undergoing combination treatment with DCB and DA in the Fifth Affiliated Hospital of Zhengzhou University was analyzed retrospectively.Twenty-two lesions were stenosis and 6 were occlusions.Color Doppler ultrasound,CT angiography or magnetic resonance angiography was used to evaluate the patency of vessels at 6,12 months postoperatively.The changes of primary patency rate,ankle brachial index(ABI),Rutherford classification,minimal lumen diameter(MLD)and complications were recorded.The SPSS 25.0 was used to analyze the data.ResultsEndovascular recanalization of the target lesions was successfully performed in all the 28 patients,and the technical success rate was 92.9%(n=26).A single femoral artery perforation and one distal embolization were observed during operation.No case of flow-limiting dissection was seen and the bailout stenting rate was 3.6%(n=1).During the follow-up period,there was no amputation or mortality in the cases.1.Target vessel primary patency rate: The primary patency rates of target vessels at 6 and 12 months after combination treatment with DA and DCB were 96.4% and 92.9%,respectively.One patient with target vessel stenosis>50% at the 5th month of follow-up and the lumen maintained patency after DCB angioplasty.Another patient developed superficial femoral artery occlusion at the 9th month of follow-up and the patency was restored after bare metal stent implantation.2.ABI and Rutherford classification:The ABIs of 6,12 months after operation were 1.01±0.18 and 0.92±0.15,respectively.Compared with preoperative ABI,the difference was statistically significant(P<0.001).Rutherford classification improved significantly in all patients after 6 and 12 months follow-up.The walking distance of patients with intermittent claudication was prolonged significantly,and all symptoms disappeared.3.Minimal lumen diameter(MLD): The MLDs were(3.85±0.67)mm and(3.29±0.52)mm at 6,12 months follow-up period respectively,which were statistically significant compared with preoperative MLD(P<0.001).ConclusionDA combined with DCB is safe and effective in the treatment of femoropopliteal lesions,with satisfactory short and mid-term results,and which can provide a new idea for endovascular treatment of femoropopliteal lesions.