Outcomes of Endovascular Interventions for Popliteal Artery Atherosclerotic Disease

Endovascular treatment of atherosclerotic disease involving the popliteal artery has been met with skepticism due to its curvature and location at a flexion point. We aimed to compare outcomes of endovascular interventions limited to the popliteal artery (group I) with those involving femoral popliteal segment (group II). A retrospective analysis of all index Vascular Quality Initiative eligible endovascular interventions for femoropopliteal occlusive disease between 2015 and 2022 at our institution was performed. Patients with acute limb ischemia or prior femoropopliteal interventions were excluded. Rates of postoperative loss of primary patency, major limb amputations and conversion to open surgical bypass at 18 months were compared across groups using Kaplan-Meier curves and Cox regression. A total of 172 patients (60 group I and 112 group II) were analyzed. Baseline demographics, lesion characteristics and treatment strategies are shown in the Table. There was no difference in prevalence of critical limb-threatening ischemia (73.3% group I and 69.9% group II; P = .69). Mean treatment length was 6.9 cm and 24.9 cm in groups I and II, respectively (P = .001). Two-thirds of patients had occlusions (66.7% group I, 69.6% group II; P = .69) and nearly one-half had severe calcification (45.6% in group I, 45.7% in group II; P = .99). There was significantly lower utilization of stents in group I. Technical success (defined as residual stenosis of ≤30%) was achieved in 75% and 85.7% of patients in group I and II, respectively (P = .02). Target lesion dissections were present in 3.3% of group I and 12.5% of group II (P = .06). Median follow-up was 14 and 12 months for groups I and II, respectively. At 18 months, there was no difference in primary patency (56.4% group I, 59.4% group II; P = .73), and freedom from major limb amputations (82.7% group I, 86.4% group II; P = .93) in patients achieving technical success. Considering all patients with an attempted endovascular intervention, there was a statistically significant higher rate of conversion to open bypass (Figure) in patients in group I compared to patients in group II after adjusting for diabetes, coronary artery disease, Rutherford score and Trans-Atlantic Intersociety Consensus grade on Cox regression analysis (hazard ratio, 0.23; 95% confidence interval, 0.06-0.86; P = .03). Endovascular interventions limited to lesions involving the popliteal artery are associated with higher technical failure rate compared to those involving the femoropopliteal segment, with a higher rate of conversion to open surgical bypass. Technical success is associated with similar near term outcomes as femoropopliteal segment.TablePatient demographics and treatment characteristicsIsolated popliteal (n = 60)Femoropopliteal (n = 112)Total (n = 172)P valueDemographics.33a Age at procedure, years71.3 ± 12.473.1 ± 10.072.5 ± 10.9.70b Male sex39 (65.0)76 (67.9)115 (66.9) Coronary artery disease31 (51.7)39 (34.8)70 (40.7).03b Diabetes43 (71.7)57 (50.9)100 (58.1).008b Preoperative aspirin48 (80.0)79 (70.5)127 (73.8).18b Preoperative antiplatelets14 (23.3)37 (33.0)51 (29.7).18b Preoperative statin49 (81.7)86 (76.8)135 (78.5).46bTreatment characteristics Rutherford score.02a1-316 (26.7)34 (30.4)50 (29.1)413 (21.7)8 (7.1)21 (12.2)5-631 (51.7)70 (62.5)101 (58.7) Tibial runoff.14a03 (5.2)1 (0.9)4 (2.4)110 (17.2)25 (23.6)35 (21.3)220 (34.5)46 (43.4)66 (40.2)325 (43.1)34 (32.1)59 (36.0)Missing268 Degree of calcification.22aMild18 (31.6)22 (21.0)40 (24.7)Moderate13 (22.8)35 (33.3)48 (29.6)Severe26 (45.6)48 (45.7)74 (45.7) Occluded lesion40 (66.7)78 (69.6)118 (68.6).69a Treated length, cm6.9 ± 6.524.9 ± 19.618.6 ± 18.4.001b Plain old balloon angioplasty only9 (15.0)7 (6.3)16 (9.3).06a Drug-coated balloon20 (33.3)40 (35.7)60 (34.9).76c Bare metal stent5 (8.3)23 (20.5)28 (16.3).04a Drug-eluting stent2 (3.3)39 (34.8)41 (23.8)<.001b Bailout stent1 (1.7)10 (8.9)11 (6.4).01b Atherectomy13 (21.7)23 (20.5)36 (20.9).86a Lithotripsy1 (1.7)2 (1.8)3 (1.7)1.000bValues are mean ± standard deviation or number (%). Open table in a new tab