ABSTRACT 1 OUTCOMES OF BALLOON ANGIOPLASTY ALONE AND OTHER ADJUNCTIVE THERAPIES IN THE TREATMENT OF BELOW-KNEE PERIPHERAL ARTERY DISEASE. Sofia Ahsanuddin1, Christopher Hatzis2, Ajit Rao2. 1Medical Education, 2 Surgery. 1,2Icahn School of Medicine at Mount Sinai, New York, New York. BACKGROUND: The use of atherectomy as an adjunctive treatment modality to treat peripheral artery disease has grown disproportionately in comparison to other procedures in the outpatient setting. Thus, despite its ubiquitous use, there is limited data on the risks and benefits of atherectomy use, including amputation rates, distal embolization rates, and the need for thrombolysis and thrombectomy. RESEARCH QUESTION: We hypothesized that atherectomy use would improve revascularization of below-knee PAD with potentially higher risk of complications. METHODS: We queried the Vascular Quality Initiative database for endovascular interventions, comorbidity data, and smoking status. We performed univariate and multivariate analyses using SPSS (n=31,603). The exposure is treatment type: 1) Balloon Angioplasty, 2) Stenting, 3) Atherectomy with Angioplasty, 4) Atherectomy with Stenting. The outcomes included were 1) current ipsilateral amputation, 2) occlusion length, 3) treatment length, 4) embolization, and 5) thrombolysis and thrombectomy. RESULTS: In diabetic patients, atherectomy with angioplasty was the preferred treatment modality (75.5%, p=0.013) compared to balloon angioplasty (73.9%), stenting (68.4%, p<0.001), and atherectomy with stenting (68.3%, p<0.001). In patients with a prior ipsilateral amputation, balloon angioplasty was the preferred modality (21.8%) compared to stenting (16.9%, p<0.001), atherectomy with angioplasty (19.3%, p<0.001), and atherectomy with stenting (16.1%, p<0.001). All three groups had lower rates of current ipsilateral amputation rates than balloon angioplasty. Additionally, when accounting for multivariate analysis, there was no significant increased risk of unplanned amputation with atherectomy use. Placement of an embolic protection device was significantly more common with procedures utilizing atherectomy (7.7% and 6.5%, p<0.001) compared to balloon angioplasty alone (0.53%). CONCLUSIONS: Atherectomy use is associated with lower risk of concurrent ipsilateral amputation compared to balloon angioplasty. There is no significantly increased risk of unplanned amputation with atherectomy use compared to balloon angioplasty. The rates of EPD placement is significantly higher in atherectomy groups, but still overall low usage (<10%).
34
