UNCORRECTED PROOF Infrainguinal Atherectomy: A Retrospective Review of a Single-Center Experience Nataliya I. Biskup, Daniel M. Ihnat, Luis R. Leon, Angelika C. Gruessner, and Joseph L. Mills, Tucson, Arizona By decreasing plaque burden, atherectomy provides an alternative to angioplasty and stenting as a means of revascularizing patients with peripheral arterial disease. A new atherectomy de- vice (SilverHawk) has recently been approved by the Food and Drug Administration, but the re- sults with its use are unclear. We analyzed a series of consecutive patients undergoing atherectomy. We retrospectively reviewed the charts of 35 patients undergoing infrainguinal (IF) atherectomy in 38 limbs. The Trans-Atlantic Inter-Society Consensus (TASC) classification and Society of Vascular Surgery runoff scores were calculated. Time to event analysis was per- formed using Kaplan-Meier estimates. Risk factors affecting patency were analyzed with a mul- tivariate Cox model. Mean patient age was 70 ± 9.6 years. Indications for intervention were claudication (26%), rest pain (21%), and tissue loss (53%). Femoropopliteal (FP) atherectomy was performed in 68% and tibial atherectomy in 32%. For FP lesions, the TASC distribution was A, 42%; B, 23%; C, 4%; and D, 15%. The average lesion treatment length was 9.4 ± 10.6 cm (range 1-40), and the runoff score was 5.1 ± 3.5. For tibial lesions, the TASC distribution was A, 0%; B, 17%; C, 8%; and D, 75%. The average lesion treatment length was 9.2 ± 6.0 cm (range 2-20), with a runoff score of 5.4 ± 2.4. A total of 39% of patients had prior IF interventions. Adjunctive angioplasty of the atherectomized lesion was performed in 55% of cases, stenting in 0%, and adjunctive therapy for tandem lesions in 39%. The postoperative ankle-brachial index increased by 0.30 ± 0.14 and toe pressures increased by 40 ± 32.4 mm Hg. Mean follow-up was 10 ± 8 months (range 0.3-23). During the studied period, seven patients required major limb amputation and five open surgical revascularization. Total primary and secondary patency rates were 66% and 70% at 1 year, respectively. Primary and secondary patency rates for FP atherectomy were 68% and 73% at 1 year, respectively. The limb salvage rate was 74% at 6 months. Patients with prior interventions in the atherectomized segment had an almost 10-fold decrease in primary patency. Atherectomy produces acceptable results, similar to those in reported series of conventional balloon angioplasty/stenting. Patients with prior IF interventions had a nearly 10-fold decrease in primary patency. A greater than sixfold decrease in patency rates was noted in patients who underwent simultaneous inflow or outflow procedures, but this finding did not reach statistical significance ( p ¼ 0.082). Future studies should focus on cost comparisons with other treatments such as angioplasty and stenting, and prospective ran- domized trials should be performed to compare these treatment alternatives. INTRODUCTION Peripheral arterial disease (PAD) continues to be a growing problem in the United States, affecting at least 6.8 million (5.8%) individuals aged 40 years or older 1 and significantly lowering their quality of life. Many centers are now relying on endovascular techniques to treat PAD, reserving open surgery for failures of endovascular therapy. 2,3 The use of Presented at the 18th Annual Winter Meeting of the Peripheral Vas- cular Surgery Society, Snowmass, CO, February 1-3, 2008. Department of Surgery, Arizona Health Sciences Center, Tucson, AZ Q1 . Correspondence to: Daniel M. Ihnat, Department of Surgery, Ari- zona Health Sciences Center, 1501 N. Campbell Avenue, P.O. Box 245072, Tucson, AZ 85724-5072, USA, E-mail: DIhnat@surgery. arizona.edu Ann Vasc Surg 2008; -: 1-7 DOI: 10.1016/j.avsg.2008.08.003 Ó Annals of Vascular Surgery Inc. Published online: --,- 1 AVSG339_proof  2 September 2008  1/7  ce 15 ARTICLE IN PRESS 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64