Peripheral interventions

Long-term outcomes of peripheral atherectomy for femoropopliteal endovascular interventions

EuroIntervention 2023;18:e1378-e1387. DOI: 10.4244/EIJ-D-22-00609

Anna Krawisz
Anna K. Krawisz1,2,3, MD; Aishwarya Raja4, MD; W. Schuyler Jones5, MD; Peter Schneider6, MD; Changyu Shen1, PhD; Marc Schermerhorn7, MD; Eric A. Secemsky1,2,3, MD, MSc
1. Department of Medicine, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA; 2. Harvard Medical School, Boston, MA, USA; 3. Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; 4. Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; 5. Division of Cardiology, Department of Medicine, Duke University Health System, Durham, NC, USA; 6. Division of Vascular and Endovascular Surgery, University of California San Francisco, San Francisco, CA, USA; 7. Division of Vascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA

Background: The use of atherectomy during peripheral endovascular interventions (PVI) has increased dramatically, but data regarding its safety and effectiveness are lacking. 

Aims: This study sought to determine the long-term safety of atherectomy in contemporary practice. 

Methods: Medicare fee-for-service beneficiaries who underwent femoropopliteal artery PVI from 2015-2018 were identified in a 100% sample of inpatient, outpatient, and carrier file data using procedural claims codes. The primary exposure was the use of atherectomy. Inverse probability of treatment weighting was used to adjust for measured differences in patient populations. Kaplan-Meier methods and multivariable Cox proportional hazards regression were used to compare outcomes. 

Results: Among 168,553 patients who underwent PVI, 59,142 (35.1%) underwent atherectomy. The mean patient age was 77.0±7.6 years, 44.9% were female, 81.9% were white, and 46.7% had chronic limb-threatening ischaemia. Over a median follow-up time of 993 days (interquartile range 319-1,377 days), atherectomy use was associated with no difference in the risk of either the composite endpoint of death and amputation (adjusted hazard ratio [aHR] 0.99, 95% confidence interval [CI]: 0.97-1.01; p=0.19) or of major adverse limb events (aHR 1.02, 95% CI: 0.99-1.05; p=0.26). Patients who underwent atherectomy had a modest reduction in the risk of subsequently undergoing amputation or surgical revascularisation (aHR 0.92, 95% CI: 0.90-0.94; p<0.01) but an increase in the risk of undergoing a subsequent PVI (aHR 1.19, 95% CI: 1.16-1.21; p<0.01).

Conclusions: The use of atherectomy during femoropopliteal artery PVI was not associated with an increase in the risk of long-term adverse safety outcomes among patients with peripheral artery disease.

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atherectomyclaudicationcritical limb ischaemiafemoropopliteal disease
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