Purpose: Peripheral artery disease (PAD) affects more than 200 million adults in the world and is frequently associated with intermittent claudication. Open surgical approaches have been used in the past but endovascular approaches have evolved as the first line of treatment. The present study details a single center real-world case series assessing the safety and efficacy of the Auryon™ atherectomy system in patients with infrainguinal PAD.
Materials and Methods: The Auryon™ atherectomy system (AngioDynamics Inc. Latham, NY) consists of a 355 nm wavelength solid-state Nd:YAG short pulse laser combined with dedicated optical catheters of various sizes. We retrospectively reviewed our single center experience in patients with infrainguinal PAD (Rutherford 3 - 6) between March 2020 through September 2020. Post-procedural patency was evaluated by duplex ultrasonography. Doppler waveforms and ABI with PVR were also evaluated to assess functionality before and following intervention. In addition, procedural adverse events were recorded to assess safety.
Results: A total of 31 patients (74 lesions) included 49.09 % of females and an average age of 73.05 years (range: 39-101). Comorbidities included diabetes, hypertension, hyperlipidemia, coronary artery disease, COPD, and history of CVA. 50% of the lesions were found in the femoropopliteal arteries, and 50% in the tibial arteries (tibioperoneal trunk, peroneal, posterior tibial, and anterior tibial arteries). Pre- and post-procedural duplex ultrasonography has been performed on 13 (41.9%) patients at this time. Pre-and post ABI with PVR have been performed on 21 (67.7%) patients. Three (9.7%) patients required reintervention, with one requiring a stent due to SFA reocclusion on 3-month follow-up. Another patient had significant improvement of symptoms, but elected for reintervention to revascularize additional tibial vessels. The third patient had stenotic recurrence in the popliteal artery on 3-month follow-up requiring intervention. Two lower extremities (3.6%) did not have restored patency following intervention with atherectomy and angioplasty and required surgical bypass – one elective, one urgent due to worsening leg pain 72 hours post procedure. No major events or complications occurred during the procedure.
Conclusion: The AuryonTM laser system was shown to be safe and effective with no procedural adverse events. However, further research and clinical studies with long term follow up and quality of life are needed to validate the benefits with this approach.
References: 1) Shu et al, Atherosclerosis 2018: 275: 379-81