EVALUATION OF THE PULLBACK ATHERECTOMY CATHETER IN THE TREATMENT OF LOWER-LIMB VASCULAR-DISEASE

Purpose: To evaluate prospectively the Pullback Atherectomy Catheter ( PAC) in terms of its technical success and 1-year patency in the treat ment of lower limb vascular disease. Methods: Thirty-nine PAC procedur es were performed in 34 patients to treat atherosclerotic disease (occ lusive in 51%) of the femoropopliteal arteries, including four cases o f graft neointimal hyperplasia and three dissection flaps. Follow-up w as by ankle-brachial indices at 24 hr and 1 month, and arteriography a t 6 and 12 months. Results: Technical success was achieved in 38 of 39 procedures (97.4%). There was a reduction in mean stenosis from 89.4% to 12.1%, but 69.2% of procedures required additional balloon dilatat ion to achieve an adequate arterial lumen. Complications followed 15.4 % of procedures, a third of which required surgery.Conclusion: The PAC is an easy and relatively safe catheter to use, but does not provide a satisfactory arterial lumen without additional percutaneous translum inal angioplasty (PTA). It proved to be effective, however, in the tre atment of graft neointimal hyperplasia and in the resection of obstruc tive intimal flaps following PTA.