VESS05 - Comparison of outcomes for the percutaneous atherectomy versus balloon angioplasty and/or stenting in the treatment of femoropopliteal disease: Based on the KSVS DAMOEUM registry

Objectives: This study assessed the effectiveness of atherectomy-assisted endovascular interventions (Atherectomy) compared to other endovascular treatments (Others) for patients with chronically occluded femoropopliteal arteries using a nationwide prospective multicenter registry.

Methods: The Korean Society for Vascular Surgery's DAMOEUM registry is a nationwide multicenter prospective registry of patients who underwent open, endovascular, or hybrid surgery for the inflow and infrainguinal arterial diseases. In this study, we retrieved the data of patients who received endovascular revascularization either by Atherectomy or Others for the femoropopliteal lesions. The analysis was conducted on a per-patient, per-procedure, and per-lesion basis. The primary endpoint was the primary patency rate. The secondary outcome was the post-procedural ankle-brachial index (ABI). Additionally, factors influencing primary patency in the Atherectomy or Other groups were assessed.

Results: A total of 424 patients were included in the final analysis; 90 in the atherectomy group and 334 in the PTA and/or stenting group. There were 344 men and 79 women (mean age, 71.1). When performed a comparison between 90 of Atherectomy and 270 of the matched cohort, the overall 1-year patency was not significantly different (83.3% vs 79.5%, p=0.820). The risk of occlusion did not significantly differ between the Atherectomy and other groups (HR 1.1, 95% CI 0.44–2.7, p=0.852). However, when considering the use of the atherectomy device and DCB, the use of the atherectomy device showed a significantly lower risk of occlusion compared to the Others group (p < 0.001). The preprocedural ABI was 0.55±0.37 and 0.40±0.36 in the Atherectomy and Others groups, respectively, and the postprocedural ABI was 0.7±0.53 and 0.66±0.53 in the Atherectomy and Others groups, respectively (p=0.015).

Conclusions: Atherectomy with PTA and/or stenting did not show a significant difference in the primary patency rate in our study. Careful selection of the proper procedure for each patient might be more important for achieving the best clinical results than the procedure itself.