Atherectomy-Associated Complications in the Southern California Vascular Outcomes Improvement Collaborative.
Academic Article
Overview
abstract
BACKGROUND: Atherectomy has become an increasingly utilized modality for the endovascular treatment of peripheral arterial occlusive disease. The objective of this study was to determine the incidence and risk factors for atherectomy-associated complications. METHODS: A retrospective review was performed for all atherectomy procedures performed between January 2011 and December 2015 in the Southern California Vascular Outcomes Improvement Collaborative. Atherectomy was defined as laser, orbital, or excisional atherectomy. Complications were dissection, perforation, and distal embolization. RESULTS: Seven hundred twenty-nine atherectomy procedures were performed at 7 institutions by 27 practitioners. The mean age was 73 years with 415 (57%) males. Four hundred nineteen (57%) were diabetic, 673 (92%) hypertensive, 457 (63%) smokers, and 244 (34%) had coronary artery disease. Dissection occurred in 51 (7%) procedures, embolization in 23 (3.1%), and perforation in 12 (1.6%). The mean number of lesions treated per artery was the same at 1.6 in patients with any complication and no complication (P = 0.77). The total occluded length was 7.4 cm for complications versus 7.2 cm for no complication (P = 0.73). The total treated length was 12.9 cm for complications versus 11.3 cm for no complication (P = 0.03). The incidence of complications for Trans-Atlantic Inter-Society Consensus (TASC) C/D lesions were 13% compared to 10% for TASC A/B lesions (P = 0.05). The incidence of complications in superficial femoral/popliteal lesions was 12.9% vs. 10.4% in tibial lesions (P = 0.13). In multivariable analysis, treatment length was associated with a small increased risk of complication (odds ratio = 1.02, 95% confidence interval = 1.0-1.04). CONCLUSIONS: Increased treatment length is associated with an increased risk of atherectomy-associated complications. Demographic factors and comorbidities were not predictors of complications.
