Recanalization of Infrainguinal Vessels

Silverhawk, Laser, and the Remote Superficial Femoral Artery Endarterectomy

Shoaib Shafique, Ryan D. Nachreiner, Michael Murphy, Dolores F. Cikrit, Alan Sawchuk, Michael Dalsing

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

There are multiple endovascular options to achieve percutaneous revascularization of chronic superficial femoral artery (SFA) stenoses and occlusions. Most rely on forceful displacement of plaque via balloon angioplasty, either as a stand-alone therapy or supplemented by cold thermal injury (cryoplasty), microtome assistance (cutting balloon angioplasty), nitinol stent deployment, or expanded polytetrafluoroethylene-lined nitinol stent deployment. Excellent technical success rates are routinely described in the literature. The essential problem associated with these techniques is the predictable compromise of the initial result by neointimal hyperplasia leading to poor long-term results. An alternative to forceful displacement techniques is use of directional atherectomy or excimer laser to debulk the atheromatous lesion, with the addition of low-pressure angioplasty or stent deployment as needed. Currently, directional atherectomy is performed using the Silverhawk Plaque Excision System (FoxHollow, Redwood City, CA), while laser atherectomy is frequently performed with the CLIRpath Excimer Laser (Spectranetics Corp., Colorado Springs, CO). While both techniques can be utilized for de novo atherosclerotic lesions, even eccentric lesions or ostial lesions, proponents of these devices have also shown good short-term results in the treatment of restenoses. Remote SFA endarterectomy with the Aspire stent (Vascular Architects, San Jose, CA) is a hybrid surgical and endovascular technique that is useful for debulking plaque from the SFA with adjunctive stenting of the distal SFA. We present a review of various alternative techniques to forceful balloon dilation used in the recanalization of the SFA with potential pitfalls and complications, along with a review of literature associated with each of these techniques.

Original languageEnglish
Pages (from-to)29-36
Number of pages8
JournalSeminars in Vascular Surgery
Volume20
Issue number1
DOIs
StatePublished - Mar 2007

Fingerprint

Endarterectomy
Femoral Artery
Atherectomy
Lasers
Stents
Excimer Lasers
Balloon Angioplasty
Sequoia
Endovascular Procedures
Polytetrafluoroethylene
Carbon Monoxide
Angioplasty
Hyperplasia
Blood Vessels
Dilatation
Pathologic Constriction
Hot Temperature
Pressure
Equipment and Supplies
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Recanalization of Infrainguinal Vessels : Silverhawk, Laser, and the Remote Superficial Femoral Artery Endarterectomy. / Shafique, Shoaib; Nachreiner, Ryan D.; Murphy, Michael; Cikrit, Dolores F.; Sawchuk, Alan; Dalsing, Michael.

In: Seminars in Vascular Surgery, Vol. 20, No. 1, 03.2007, p. 29-36.

Research output: Contribution to journalArticle

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