December 12, 2008

Mechanical SilverHawk Atherectomy as First- Line Stand-Alone Therapy for SFA Lesions

Luis R. Davila-Santini, MD, Feng Qin, MD, Lorena P. DeMarco-Garcia, MD, Julio Calderin, MD, Rajeev Dayal, MD, Toufic K. Safa, MD, Kambhampaty V. Krishnasastry, MD.
North Shore-LIJ Health System, New York, NY, USA.

Objective: To evaluate the efficacy of SilverHawk atherectomy(SA) for SFA lesions at an institution routinely utilizing SA as first-line therapy for chronic limb ischemia(CLI).
Methods: Using a prospectively acquired database, we retrospectively identified all patients who underwent SA for superficial femoral artery (SFA) lesions without inflow or outflow treatment between 7/2005 and 1/2008. Demographic data, comorbidities, indications and outcomes were extracted.
Results: Thirty-one SFA lesions in 27 patients were treated with SA. Mean age was 72 years (range 59-88 years). Indications included severe claudication in 20/27 (74%) patients and limb-threatening ischemia in 7/27(26%) patients. After atherectomy, adjunctive percutaneous transluminal angioplasty (PTA) with or without stent placement was performed for residual stenosis ≥70% and was required in 22/31(71%) lesions (Table 1). Physical exams, ankle-brachial indices (ABI) and arterial duplex scans were performed every 3 months. Mean ABIs improved from 0.32 +/- 0.19 to 0.68 +/-0.16, and improved >0.2 in 26/31(84%) lesions. Complications included distal embolization in 5/31(16%) lesions and perforation in 1/31(3%) lesions. No systemic complications or mortalities occurred. Median follow-up was 16 months (range 4-24 months). Primary patency rates at 6 and 12 months and limb salvage rate at 1 year were 84%, 68% and 88%, respectively. SA alone was successful in 5/6 (83%) TASC A lesions, and patency was higher in patients with ≥2 vessel runoff and nondiabetics.

Conclusions: Acceptable angiographic result with SA as stand-alone therapy in SFA lesions was seldom achieved. Significant distal embolization rates warrant caution and distal protection. Due to comparable patency and superior cost-effectiveness of PTA, we abandoned SA as first-line therapy for SFA lesions, regardless of severity.
Table 1. Lesion severity and treatment modality


	SA alone	SA + PTA	SA + PTA + Stent	Total
SFA lesions	9 (29%)	4 (13%)	18 (58%)	31
TASC A	5	1	0	6 (19%)
TASC B	4	3	6	13 (42%)
TASC C/D	0	0	12	12 (39%)

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