Abstract

Percutaneous transluminal angioplasty (PTA) has become the standard endovascular treatment for peripheral arterial disease. In complex lesions with severe calcification, drug penetration into the vessel wall is reduced and the risk of dissection increases. Especially in complex femoropopliteal lesions, vessel preparation with directional atherectomy (DA) before PTA may improve procedural success, reduce the need for stenting, and affect short- and mid-term outcomes compared with PTA alone. This study aimed to investigate these effects. Patients who underwent endovascular treatment for symptomatic (Rutherford 2–5) peripheral arterial disease at the Alanya Training and Research Hospital, Department of Cardiovascular Surgery, between January 2021 and January 2025 were retrospectively analyzed. Patients were divided into two groups as follows: Study group: 46 patients treated with atherectomy + PTA, Control group: 68 patients treated with PTA alone. Demographic data, lesion characteristics, procedural details, and early and mid-term complications were compared. In the atherectomy group, residual stenosis rates after atherectomy were significantly reduced, allowing balloon dilation at lower pressures. In line with the literature, stent implantation rates in severely calcified lesions were lower in the atherectomy group compared to the control group. No procedure-related mortality or major amputation was observed in either group. In patients with peripheral arterial disease, plaque debulking with atherectomy before drug-coated balloon treatment increases vessel compliance, reduces dissection risk, and lowers the need for stent implantation. As part of a comprehensive arterial flow maintenance strategy, atherectomy is a safe and complementary method that enhances the effectiveness of PTA.

Key words: Peripheral arterial disease, angioplasty, atherectomy, treatment