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The Journal of Cardiovascular Surgery 2022 February;63(1):13-9

DOI: 10.23736/S0021-9509.21.12159-7


language: English

Technical performance and reproducibility following rotational atherectomy of femoropopliteal artery occlusive lesions: analysis of the multicenter MORPHEAS Registry

Konstantinos P. DONAS 1 , Gergana T. TANEVA 1, Georgios A. PITOULIAS 2, Amer JOMHA 3, Martin SCHRÖDER 4, Anastasios PSYLLAS 5, Salvatore SCALI 6, Nizar ABU BAKR 1, MORPHEAS Registry 

1 Department of Vascular and Endovascular Surgery, Asklepios Clinic Langen, Goethe-University of Frankfurt, Langen, Germany; 2 School of Medicine, Division of Vascular Surgery, Second Department of Surgery, G. Gennimatas Hospital, Aristotle University Thessaloniki, Thessaloniki, Greece; 3 Department of Vascular Surgery; Klinicum Bad Hersfeld, University of Giessen, Bad Hersfeld, Germany; 4 Clinic of Vascular Surgery, Marien Hospital Herne, Ruhr-University of Bochum, Herne, Germany; 5 Department of Vascular Surgery, Marien Hospital Wesel, University of Cologne, Wesel, Germany; 6 Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, USA

BACKGROUND: The purpose of this study was to define patient and anatomical factors associated with technical results specific to rotational atherectomy. Controversy exists surrounding appropriate utilization of atherectomy to treat femoral-popliteal atherosclerosis. Importantly, the existence of different atherectomy devices and lack of technical reports highlighting variables that impact outcomes obscures the ability to assess perioperative performance.
METHODS: The nonindustry sponsored, Multicentric National Registry on the use of rotational atherectomy in femoral-popliteal occlusive atherosclerotic disease (MORPHEAS) database was queried. The MORPHEAS investigators included experienced providers at four centers who previously had not utilized rotational atherectomy. The primary endpoint was flow-limiting dissection and/or >50% recoil resulting in stent-placement while a secondary endpoint included peripheral thromboembolism incidence.
RESULTS: One hundred thirteen patients were enrolled. Only femoropopliteal occlusions were included in the analysis and anatomic distribution and calcification severity were depicted separately. The most common adjunctive therapy was drug-coated balloon angioplasty (84%; N.=96). Flow-limiting dissection was identified in 16% (N.=18) and thromboembolism occurred in 4% (N.=4). Diabetes increased risk of thromboembolism (P=0.03) while lesion length ≥8.0 cm (P=0.07) and SFA-popliteal adductor canal location (P=0.01) were associated with flow-limiting dissection. In multivariable analysis, SFA-popliteal adductor canal occlusion had a 4.7-fold risk of perioperative complications (OR=4.7, 95%CI: 1.1-21.0; P=0.04).
CONCLUSIONS: Rotational atherectomy was characterized by reproducible performance among four centers; however, diabetic patients, as well as those with long-segment, heavily calcified SFA-popliteal adductor canal occlusion present greatest risk of complications.

KEY WORDS: Atherectomy; Calcification, physiologic; Cardiology

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