Endovascular treatment of atherosclerotic popliteal artery disease based on dynamic angiography findings

• Published in: Journal of vascular surgery 2017-01, Vol.65 (1), p.82-90
• Main Authors: Cui, Chaoyi, MD, PhD, Huang, Xintian, MD, Liu, Xiaobing, MD, PhD, Li, Weimin, MD, Lu, Xinwu, MD, PhD, Lu, Min, MD, Jiang, Mier, MD, Yin, Minyi, MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Alloys; Amputation; Angiography - methods; Angioplasty, Balloon - adverse effects; Angioplasty, Balloon - instrumentation; Angioplasty, Balloon - mortality; Ankle Brachial Index; Atherosclerosis - diagnostic imaging; Atherosclerosis - mortality; Atherosclerosis - physiopathology; Atherosclerosis - therapy; China; Critical Illness; Female; Humans; Ischemia - diagnostic imaging; Ischemia - mortality; Ischemia - physiopathology; Ischemia - therapy; Kaplan-Meier Estimate; Limb Salvage; Male; Popliteal Artery - diagnostic imaging; Popliteal Artery - physiopathology; Predictive Value of Tests; Proportional Hazards Models; Prosthesis Design; Retreatment; Retrospective Studies; Risk Factors; Stents; Surgery; Survival Rate; Time Factors; Treatment Outcome; Vascular Patency
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2016.05.087

Abstract Objective To evaluate efficacy, safety, and midterm patency of endovascular treatment of obstructive popliteal artery (PA) disease. Methods A retrospective evaluation of patients with atherosclerotic PA disease who underwent percutaneous transluminal balloon angioplasty and provisional stent, based on both conventional and dynamic angiographies, was conducted from June 2011 to June 2014. Forty-three patients were included in the study, and most patients had limited surgical revascularization options. Demographic characteristics, angiographic findings, interventional data, complications, vessel patency, limb salvage rates, and survival rates were analyzed. Results The median lesion length was 5 cm with 72.1% having total occlusions. The second popliteal segment (P2) was involved most frequently (60.5%, n = 26). Critical limb ischemia was present in 69.8%. The technical success rate was 92.9% (42/43 limbs), with 29 cases requiring adjunctive nitinol stents after balloon angioplasty (47.6% based on conventional angiography, 21.4% based on dynamic angiography, and 4.8% additional stents based on dynamic angiography). Complications included thromboembolism (2.3%), perforation (2.3%), pseudoaneurysm (2.3%), and myocardial infarction (2.3%). Stent fracture was present in three cases (7.1%) during the mean follow-up period of 18.3 months. The baseline ankle-brachial index significantly improved after the intervention, from 0.49 ± 0.11 to 0.92 ± 0.14 ( P  < .01). The Rutherford-Becker class decreased from 3.95 ± 0.76 to 1.76 ± 0.95 ( P  < .01) at 12 months. The 1-year primary, primary-assisted, and secondary patency rates were 75.2% ± 6.8%, 82.4% ± 6.0%, and 89.9% ± 4.8%, respectively. The limb salvage and amputation-free survival rates at 12 months were 91.6% and 87.0%, respectively. Conclusions Balloon angioplasty with a provisional stent based on dynamic angiography is a feasible, safe, and effective therapy for patients with obstructive PA disease. Although the occurrence of stent fracture is still inevitable, patients with critical limb ischemia who have limited surgical options may get more benefits from the endovascular treatment of PA obstructive diseases.