Print this pageIntermediate Results Of Percutaneous Endovascular Therapy Of Femoropopliteal Occlusive Disease: A Contemporary Series
Mark F Conrad, Richard P Cambria, David H Stone, David C Brewster, Christopher J Kwolek, Michael T Watkins, Glenn M LaMuraglia
Massachusetts General Hospital, Boston, MA
INTRODUCTION AND OBJECTIVES:
Percutaneous interventional therapy (PI) is becoming a primary option for managing infrainguinal occlusive disease. The purpose of this study is to examine the clinical utility of PI with intermediate follow-up in a contemporary series.
METHODS:
This review included 238 consecutive femoropopliteal PI (208 pateints) from 1/2002-7/2004. End points including: 1ºpatency, assisted patency and limb salvage (SVS standards) were assessed by Kaplan-Meier life-table analysis and factors predictive of failure were evaluated by multivariate methods.
RESULTS:
Clinical demographics included: mean age 72yrs, male 62%, critical limb ischemia 46%, diabetes 49%, renal insufficiency 29% and lesions were classified as TASC A(11%), B(43%), C(41%) and D(5%). PI was confined to the femoropopliteal segment in 77(33%) and involved multiple segments in 161(67%). Interventions included angioplasty only in 183(78%) while the remaining 53(22%) received at least one stent. Technical success was 97% with no mortality and a major morbidity of 3%. The 36 month 1ºpatency was 54.3% with assisted patency of 92.6%(31(13%) peripheral reinterventions) and limb salvage of 95.4%. Interval conversion to bypass surgery occurred in 12(5%) patients. Comparison between critical limb ischemia and claudication revealed a 1ºpatency of 40.8%vs64.8%, assisted patency of 93.8%vs92.6% and limb salvage of 89.7%vs100% respectively. Negative predictors of 1ºpatency included: CHF(p=0.005), critical limb ischemia(p=0.002), occlusion(p=0.003) and TASC C/D(p=0.002). However, further evaluation of TASC C/D vs A/B revealed an assisted patency of 89.7%vs94.3% (p=0.37) and limb salvage of 94.3%vs96.4% (p=0.58).
CONCLUSIONS:
Femoropopliteal PI can be performed safely with a high incidence of success. Interval intermediate durability correlates primarily with extent of anatomic disease. While secondary intervention may be necessary to maintain patency in TASC C/D lesions, these data suggest that PI should be first line therapy for femoropoliteal occlusive disease regardless of TASC severity.