Abstract 17124: Comparative Outcomes of Below-the-Knee Atherectomy Interventions: A Report From the XLPAD Registry

Background: Atherectomy devices are used during below-the-knee (BTK) artery interventions to tackle the calcium burden in peripheral arteries.

Methods: We examined 1542 patients from the XLPAD Registry (NCT01904851) from 2006-2021 who underwent BTK endovascular intervention, stratified by use of atherectomy device or not. The primary outcome was the incidence of major adverse limb events (MALE), a composite of all-cause death, clinically driven revascularization, amputation, non-fatal myocardial infarction (MI), and stroke.

Results: 710 (46%) patients were treated with an atherectomy device and 832 were not. Mean age 68 years, predominantly male (72%) and Caucasian (58%). Cardiovascular risk factors were equally distributed among both groups, except hyperlipidemia was more prevalent in the atherectomy group (83% vs. 78%, p=0.01). Both groups had similar Ankle-Brachial Indexes. Atherectomy group had more multivessel interventions (2.5 vs 1.9 lesions per case, p<0.001) and SFA (54% vs. 38%, p<0.001) and popliteal artery (31% vs. 26%, p<0.001). Exclusive BTK interventions were evenly distributed between the groups. Atherectomy patients had greater calcification burden (32% vs 21%, p<0.001), diffuse disease (58% vs. 47%, p<0.001) and in-stent restenosis (9% vs. 4%, p<0.001). Stents and conventional balloon use were evenly distributed, but atherectomy patients received more drug-coated balloon treatments (10% vs 7%, p=0.04). Fluoroscopy time was longer in atherectomy group (33 min vs. 30 min, p= 0.04) with higher rates of procedural (94% vs. 91%, p=0.01) and technical success (98% vs. 93%, p<0.001). Only 30-day rate of amputation was higher among non-atherectomy patients (2% vs. 6%, p<0.001). There were no differences in the MALE (24% vs. 22%, p=NS), only surgical revascularization at 12-month follow-up more frequent in the non-atherectomy group (1% vs. 2%, p=0.01).

Conclusion: Atherectomy use is high at 46% of all BTK artery interventions in the XLPAD Registry with higher technical success than non-atherectomy interventions without differences in MALE events at 12-month follow-up.