Atherectomy - The Options, the Evidence, and When Should It Be Used.
Ann Vasc Surg
; 107: 127-135, 2024 Oct.
Article
em En
| MEDLINE
| ID: mdl-38583766
ABSTRACT
The use of atherectomy for peripheral vascular interventions (PVIs) has increased exponentially and reached 18% of all PVI in the United States. The theoretical benefit on extensive arterial calcification relies on the concept of plaque modification and removal instead of displacement, as with other endovascular techniques. To date, there are no prospective studies comparing the different atherectomy technologies (directional, rotational, orbital, and laser). Moreover, most related prospective comparative studies have a small number of patients, and larger studies are single arm in patients with relatively mild to moderate disease burden. While available literature shows lower dissection risk and reduced bailout stenting, the superiority of this technology compared to other endovascular techniques has yet to be proven. Despite the lack of level 1 evidence to support its superiority, the lucrative reimbursement fueled the overuse of this technology as first-line therapy, particularly in office-based laboratories and ambulatory surgery centers. The use of atherectomy ought to be selective and complementary to other endovascular technologies, and individualized patient-level decision-making based on the practitioner's preference and expertise is essential to selectively incorporate atherectomy in managing complex atherosclerotic lesions.
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Base de dados:
MEDLINE
Assunto principal:
Aterectomia
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Seleção de Pacientes
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Medicina Baseada em Evidências
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Doença Arterial Periférica
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Tomada de Decisão Clínica
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article