REVIEWS  NEW DEVELOPMENTS IN THE TREATMENT OF COMPLEX LOWER EXTREMITY LESIONS 

The Journal of Cardiovascular Surgery 2015 February;56(1):43-54

Copyright © 2015 EDIZIONI MINERVA MEDICA

language: English

Atherectomy in complex infrainguinal lesions: a review

Engelberger S. ¹, Van Den Berg J. C. ² ✉

¹ Service of Vascular Surgery, Ospedale Regionale di Lugano, Lugano, Switzerland; ² Service of Interventional Radiology, Ospedale Regionale di Lugano, Lugano, Switzerland

In the femoropopliteal segment, endovascular revascularization techniques have gained the role as a first line treatment strategy. Nitinol stent placement has improved the short- and midterm primary patency rates in most lesion types and is therefore widely applicated. Stenting has several shortcomings as in-stent restenosis, stent fractures and foreign material being left behind in the vessel. The concept of atherectomy is plaque debulking. This results in a potential reduction of inflation pressure requirements in angioplasty. Stent placement and consecutive in-stent restenosis may be avoided. In this non systematic literature review, the perfomance of different atherectomy techniques, such as direct atherectomy, orbital atherectomy, laser debulking and rotational atherectomy in the treatment of complex femoropopliteal lesions, including long lesions, moderately to heavily calcified lesions as well as occlusions and in-stent restenosis, has been analyzed.