Endovascular Therapy for Femoropopliteal Artery Disease and Association of Risk Factors With Primary Patency

Abstract

The treatment of femoropopliteal artery disease remains controversial, without clear guidelines specifying the indications for endovascular therapy (EVT). Accordingly, we retrospectively examined our experience of using EVT to treat femoropopliteal artery disease. A total of 91 limbs in 82 patients underwent EVT for the treatment of femoropopliteal artery disease. Percutaneous transluminal angioplasty alone was performed in 20 limbs, and additional stenting was performed in 71 limbs. The 1-year primary patency, primary-assisted patency, limb salvage, and survival rates were 76%, 88%, 96%, and 92%, respectively. Multivariate Cox analysis of primary patency showed that critical limb ischemia (CLI; hazard ratio [HR], 2.53; 95% confidence interval [CI], 1.08-5.33; P < .01) and TASC II C/D disease (HR, 2.70; 95% CI, 1.14-6.39; P < .05) were independent predictors of decreased primary patency. In conclusion, patients with CLI or extensive lesions have reduced patency after EVT for femoropopliteal artery disease.

Keywords

peripheral artery disease endovascular therapy femoropopliteal artery

Get full access to this article

View all access options for this article.

References

Norgren

Hiatt

Dormandy

. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg. 2007;45(suppl S):S5–S67.

Conrad

Cambria

Stone

. Intermediate results of percutaneous endovascular therapy of femoropopliteal occlusive disease: a contemporary series. J Vasc Surg. 2006;44(4):762–769.

Shah

Hingorani

Ascher

. Full metal jacket stenting of the superficial femoral artery: a retrospective review. Ann Vasc Surg. 2011;25(1):127–131.

Adam

Beard

Cleveland

. Bypass Versus Angioplasty in Severe Ischaemia of the Leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005;366(9501):1925–1934.

Nishibe

Kondo

Nishibe

. Stent placement for superficial femoral arterial occlusive disease in high risk patients: preliminary results. Surg Today. 2009;39(1):21–26.

Rutherford

Baker

Ernst

. Recommended standards for dealing with lower extremity ischemia. J Vasc Surg. 1997;26(3):517–538.

Fujihara

Fukata

Odashiro

Maruyama

Akashi

Yokoi

. Reduced plasma eicosapentaenoic acid-arachidonic acid ratio in peripheral artery disease. Angiology. 2013;64(2):112–118.

Davies

Waldman

Pearson

. Comprehensive endovascular therapy for femoropopliteal arterial atherosclerotic occlusive disease. J Am Coll Surg. 2005;201(2):275–296.

Pereira

Albers

Romiti

. Meta-analysis of femoropopliteal bypass grafts for lower extremity arterial insufficiency. J Vasc Surg. 2006;44(3):510–517.

10.

Surowiec

Davies

Eberly

. Percutaneous angioplasty and stenting of the superficial femoral artery. J Vasc Surg. 2005;41(2):269–278.

11.

Soga

Iida

Hirano

Suzuki

Tosaka

Yokoi

Nobuyoshi

. Utility of new classification based on clinical and lesional factors after self-expandable nitinol stenting in the superficial femoral artery. J Vasc Surg. 2011;54(4):1058–1066.

12.

Trocciola

Chaer

Dayal

. Comparison of results in endovascular interventions for infrainguinal lesions: claudication versus critical limb ischemia. Am Surg. 2005;71(6):474–479.

13.

Conrad

Cambria

Stone

. Intermediate results of percutaneous endovascular therapy of femoropopliteal occlusive disease: a contemporary series. J Vasc Surg. 2006;44(4):762–769.

14.

Conte

Geraghty

Bradbury

. Suggested objective performance goals and clinical trial design for evaluating catheter-based treatment of critical limb ischemia. J Vasc Surg. 2009;50(6):1462–1473.

15.

Haider

Kavanagh

Forlee

. Two-year outcome with preferential use of infrainguinal angioplasty for critical ischemia. J Vasc Surg. 2006;43(3):504–512.

16.

Gur

Lee

Akopian

. Clinical outcomes and implications of failed infrainguinal endovascular stents. J Vasc Surg. 2011;53(3):658–667.

17.

Dearing

Patel

Compoginis

. Primary stenting of the superficial femoral and popliteal artery. J Vasc Surg. 2009;50(3):542–548.

18.

Ihnat

Duong

Taylor

. Contemporary outcomes after superficial femoral artery angioplasty and stenting: the influence of TASC classification and runoff score. J Vasc Surg. 2008;47(5):967–974.

19.

Al-Nouri

Krezalek

Hershberger

. Failed superficial femoral artery intervention for advanced infrainguinal occlusive disease has a significant negative impact on limb salvage. J Vasc Surg. 2012;56(1):106–110.

20.

Sabeti

Schillinger

Amighi

. Primary patency of femoropopliteal arteries treated with nitinol versus stainless steel self-expanding stents: propensity score-adjusted analysis. Radiology. 2004;232(2):516–521.

21.

Schillinger

Sabeti

Loewe

. Balloon angioplasty versus implantation of nitinol stents in the superficial femoral artery. N Engl J Med. 2006;354(18):1879–1878.