Combined use of atherectomy and drug-coated balloon for endovascular treatment of femoropopliteal artery disease

Patients and methods: Between June 2016 and September 2018, a total of 45 patients (32 males, 13 females; mean age 66.2±11.9 years; range, 36 to 87 years) who underwent combined atherectomy and DCB treatment for femoropopliteal artery disease in our clinic were retrospectively analyzed. The demographic data, Rutherford Category, Ankle-Brachial Index, and lesion characteristics were recorded. Stent implantation was allowed only in case of flow-limiting dissection or recoil after prolonged balloon inflation.

Results: Procedural and clinical success were achieved in all cases. Flow-limiting dissection was seen in six patients (13.3%) after atherectomy. Provisional stent was performed to these patients. Additional DCB was performed in 39 patients. Mean follow-up was 12.7±7.5 (range, 0.5 to 28.1) months. Two minor amputations were performed to achieve complete wound healing. There was no major amputation and no mortality. Re-occlusion was seen in six patients (13.3%) and target lesion revascularization (TLR) was performed to these patients. The rate of freedom from TLR was 86.7%.

Conclusion: Our study results suggest that combined use of atherectomy and DCB may be a potential alternative strategy for the treatment of femoropopliteal artery disease. Atherectomy before balloon angioplasty may reduce the rate of significant dissection and, therefore, may be a valuable option for minimizing the need for bailout stenting.