Mid-term outcomes of directional atherectomy for femoropopliteal lesions
AbstractBackground. The femoropopliteal segment is one of the most frequent targets of an atherosclerotic lesion of lower-limb arteries, which is usually associated with an unfavorable clinical course and increased risk of amputation.
Objective. To assess the mid-term results of directional atherectomy in patients with atherosclerotic lesions of the femoropopliteal segment.
Patients and methods. We analyzed treatment outcomes in 20 patients with chronic lower limb ischemia stage IIb–III according to the A.V. Pokrovsky classification, corresponding to Rutherford categories 2–4, who underwent directional atherectomy between February 1, 2022 and May 30, 2025 for stenoses ≥50% or occlusions of the superficial femoral artery and/or proximal popliteal artery segments (P1–P2). The assessed parameters included technical success, the rate of bailout stenting, perioperative complications, changes in the ankle-brachial index (ABI), pain-free walking distance, as well as primary patency and freedom from clinically driven target lesion revascularization (CD-TLR) at 12 months.
Results. Technical success was achieved in all patients. In 16 patients (80%), the intervention was completed without stent implantation; bailout stenting was required in 4 cases (20%) due to persistent flow-limiting dissection or marked elastic recoil. The ABI increased from 0.62±0.10 to 0.91±0.08 (p<0.01), and pain-free walking distance increased from 142±50 to 312±85 m (p<0.01). Perioperative complications were observed in 4 patients and were minor in nature: distal embolization was registered in 2 cases, and local vascular access-site complications in another 2 patients. No in-hospital mortality occurred. At 12 months, primary patency was 80%, freedom from CD-TLR was 90.0%, limb salvage was 100%, and no major adverse limb events (MALE) were registered.
Conclusion. In this single-center study, duplex ultrasound-assessed primary patency of the target segment at 12 months after endovascular femoropopliteal revascularization using directional atherectomy was maintained in 16 of 20 patients and amounted to 80%. The obtained data confirm the clinical feasibility of this technique as part of a lesion preparation strategy, provided that patient selection is appropriate and lesion morphology is taken into account.
Keywords:femoropopliteal segment; peripheral artery disease; chronic lower limb ischemia; directional atherectomy; lesion preparation; balloon angioplasty; drug-coated balloon; primary patency; clinically driven target lesion revascularization
Authors’ contribution. Study conception and design – Petrosyan K.V., Musaev M.K., Karaev A.V., Grigorov G.G.; data collection and handling – Grigorov G.G., Pashukov A.Z., Tumanyan N.O., Karaev A.V.; statistical processing – Grigorov G.G., Tumanyan N.O., Pashukov A.Z.; draft manuscript preparation – Grigorov G.G., Karaev A.V.; manuscript revision – Petrosyan K.V., Musaev M.K., Papitashvili V.G., Golukhova E.Z.
For citation: Petrosyan K.V., Musaev M.K., Karaev A.V., Grigorov G.G., Pashukov A.Z., Tumanyan N.O., Papitashvili V.G., Golukhova E.Z. Mid-term outcomes of directional atherectomy for femoropopliteal lesions. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2026; 32 (3): 93–103. DOI: https://doi.org/10.33029/1027-6661-2026-32-3-93-103
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