PERCUTANEOUS PERIPHERAL ROTATIONAL ABLATION USING THE ROTABLATOR - IMMEDIATE AND MID TERM RESULTS - SINGLE-CENTER EXPERIENCE CONCERNING 146LESIONS TREATED

In order to assess the role of percutaneous peripheral rotational abla tion using Rotablator (PPRA), 95 symptomatic patients (58 M, 37 F, m. age: 77 +/- 1 y) (r: 50-90 y) having 146 peripheral vascular lesions ( PVL) were treated by PPRA. 59% were below the knee and 41% above. The runoff status (n of distal leg art. involved) was as follows: 3:52 pts , 2:23 pts, 1:14 pts, 0:6 pts. The femoral lesions were significantly longer than those at other sites (5.27 +/- 0.43 vs 2.97 +/- 0.3 cm) (p <0.001). The mean length was 3.73 +/- 0.26 cm (r: 1-20 cm). Complement ary PTA was significantly (p<0.001) more frequent in femoro-popliteal (32 PTA/48 Fem, 5 PTA/12 Pop) than in distal leg lesions (10/86 art.). Results. After PPRA alone (99 PVL) the stenosis % decreased from 81 /- 0.75 to 18 +/- 1.1. The residual stenosis was greater at femoral (2 6 +/- 2.3 %) than at distal leg level(16 +/- 1.2%) (p<0.01). Complemen tary PTA (47 PVL) lowered residual stenosis from 44% to 13%. 52 compli cations (spasm, perforation, dissection, distal emboli, no reflow, oth ers) were cured in 47 PVL. Thus our primary technical success per PVL was 97% and per pt 95%. The mean follow-up period was 11 +/- 1 mths (r : 1-37 m). Among 78 pts having a follow-up period greater than or equa l to 4 mths, 74 pts representing 115 treated PVL underwent an angiogra phy control (2 deaths, 2 lost for follow-up). 87 lesions (76%) showed no restenosis and 28 lesions (34%) showed restenosis of 83 +/- 2.4% (r : 50-100%). The restenosis rate was higher in femoral (12/21: 36%) tha n in distal (15/58: 21%) or popliteal arteries (1/8: 12%). Restenosis was more frequent for PVL greater than or equal to cm (67% vs 16%) (p< 0.001) at all sites. This result together with the complication rate w ould seem to indicate that lesions greater than or equal to 6-7 cm wou ld be a limitation for PPRA. Conclusions. In our experience Percutaneo us Peripheral Rotational Ablation has taken a pre-eminent position in the treatment of distal leg arteries. Our results lead us to broaden i ts indications to complex vascular lesions. The possibility of runoff treatment should allow an improvement in the long-term patency of PTA and bypass grafts.