Multiple Atherectomy and Patch Plasty in Diffuse Atherosclerotic Peripheral Vascular Disease: Our Experience

Abstract

Background: Peripheral vascular disease of lower limbs is a debilitating condition with a significant proportion of patients having diffuse, long segment atherosclerosis. This study emphasizes the role of surgery in this group of patients. Materials and Methods: Eighty patients (95 legs) met the inclusion criteria for this study and were followed prospectively. Patients with Rutherford Class IV–VI were taken. Operative findings (type of operation, number of patches, total length of patches, etc.) were recorded. Subsequently, in postoperative period, they were evaluated for improvement in clinical (Rutherford) class, appearance of distal pulsations, ulcer healing, primary patency rates, freedom from amputation, and associated complications at 1, 3, 6, 12, 18, and 24 months. Results: Sustained clinical treatment efficacy according to Rutherford was 82% at 12 months and 59% at 24 months. Amputation-free survival rate was 86% at 12 months and 74% at 24 months. Until 24 months, 17 legs were amputated (18%) and 10 (10.5%) target limbs were revascularized through femoral embolectomy. At 2 years, cumulative femoral artery patency was 88%, whereas cumulative popliteal artery patency was 71%. Conclusion: The present series evaluated patients with the most advanced form of critical leg ischemia with a high rate of leg salvage with this procedure. Multiple atherectomy with patch plasty does offers hope to such patients and can become part of armamentarium of a vascular surgeon.

Keywords

• Critical leg ischemia
• patch plasty
• peripheral vascular disease