Percutaneous atherectomy with the Kensey catheter: early and midterm results in femoropopliteal occlusions unsuitable for conventional angioplasty.

Forty-six femoropopliteal occlusions in 44 patients (aged 45-95 years) were recanalized with the percutaneous rotating tip atherectomy catheter completed by balloon dilatation. Thirty-one patients had tight intermittent claudication of the lower limbs, five had resting pain and 10 had skin disorders. The length of the occlusion ranged from 2 to 24 cm. Of 46 procedures, 40 (87%) were immediately successful (increase of mean Doppler systolic ankle-arm index from 0.44 to 0.89) and six (13%) were failures. In two it was impossible to pass through the lesion and in four arterial perforation occurred without any clinical consequences. Of the six failures, five occurred in calcified arteries. Five recanalizations (11%) reoccluded within 48 hours, bringing the total number of early failures to 11. Of these 11 failures, nine were treated by femoropopliteal vein bypass and two by medical treatment only. Two postoperative asymptomatic posterior tibial artery embolisms were treated medically, and one popliteal artery embolism was treated using a Fogarty catheter. At the present time, 25 of 35 primary successes had been followed for six months, and 20 for 12 months with primary patencies 18 of 25 (72%) and 14 of 20 (70%), respectively. If massively calcified lesions are excluded, femoropopliteal recanalization with the percutaneous rotary Kensey atherectomy catheter followed by balloon catheter dilatation is efficacious and reliable with an 80% primary success rate and a 70% patency rate at one year.