Plaque Excision of Infrapopliteal Arteries

Plaque Excision of Infrapopliteal Arteries for Limb Salvage

Purpose: To report our experience with a new device for excision of plaque in arterial occlusive disease involving the tibial and peroneal arteries.

Material and Methods: Forty infrapopliteal arteries in 29 patients suffering from nonhealing ischemic ulcers of the foot were treated with a new plaque excision catheter. All patients were going to have major amputation if revascularization was not successful. Eighteen patients (62%) had plaque excision as the only treatment. The other nine (30%) had adjunct PTA, stent or stent graft. Five patients (17%) needed a second procedure (not plaque excision) before the ischemic lesions were completely healed. All excised specimens were photographed and submitted for pathological examination. All patients were followed and had a color Doppler flow imaging examination at six weeks and three months. If the ulcers were healed, the patients are being seen at six-month intervals.

Results: Twenty-seven patients (93%) were treated successfully avoiding major amputations. Twelve patients (41%) had to have toe amputation while two patients (7%) had a transmetatarsal amputation. Two patients (7%) had to have below knee amputation. No re-stenosis was seen among the patients who had follow-up examinations by angiography or color Doppler flow imaging up to nine months.

Complications: There were two complications both arterial venous fistulas developing at the site of treatment, one in the anterior tibial artery, not requiring any treatment and the second was in the common tibioperoneal trunk artery, which was treated successfully with a 5mm stent graft.

Conclusion: Plaque excision is a promising new technology for treatment of peripheral arterial disease, especially in infrapopliteal arteries. It appears to have a favorable patency rate superior to angioplasty alone. However, a larger experience with a much longer follow-up is needed for better evaluation.