Endovascular Interventions for Isolated Popliteal Lesions in Chronic Limb Threatening Ischemia

• DOI: 10.1016/j.jvs.2024.03.355
• Publication Date: 2024-05-20T06:37:21Z
• Authors: Randall A. Bloch; Elisa Caron; Katie E. Shean; Scott G. Prushik; Mark F. Conrad
• Keywords: Limb ischemia; Popliteal artery; Critical limb ischemia

The Best-CLI trial confirmed the superiority of infra-inguinal bypass with single-segment great saphenous vein (ssGSV) over an endovascular-first approach for chronic limb-threatening ischemia (CLTI). However, patients without suitable ssGSV conduit, and those who are not appropriate surgical candidates, is preferred. Despite voluminous literature regarding percutaneous interventions in lower extremity, there a paucity data evaluating endovascular therapies isolated popliteal disease. objective this study was to examine outcomes CLTI. Vascular Quality Initiative (VQI) database queried all artery performed CLTI 2017-2021. Patients survived index hospitalization available long-term follow-up were included. primary endpoint freedom from above-ankle amputation. Procedures also stratified by presenting symptom intervention. A total 2978 procedures Of these, 778 (26.1%) plain balloons (POBA), 799 (26.8%) special (drug-coated, cutting, or lithotripsy), 825 (29.5%) stents, 501 (16.9%) atherectomy. Overall, 2219 (74.5%) wounds tissue loss (TL), 217 (7.3%) major amputations. treated stents (95.0% vs 93.4%; P = .003) atherectomy (95.2% 92.2%; .011) had higher amputation than remaining cohort (Table 1). stent group driven primarily utilization TL (67.8% 77.1% non-stent group; < .001). When stratifying symptom, associated among on both univariate (95.6% 90.9%; .001) 1; Fig1) multivariable analysis (HR, 0.497; .026) 3), but (93.7% 91.0%; .059) 2). Stents balloon therapy alone, more often used rest pain, which likely contributes their favorable outcome. selecting specifically, other interventions. Table IAbove-ankle (n 2978)AmputationNo AmputationTotalP-valueStent41 (5.0%)784 (95.0%)825.003Atherectomy24 (4.8%)478 (95.2%)502.011POBA64 (8.2%)714 (91.8%)778.180Special balloon74 (9.3%)725 (90.7%)799.023Total217 (7.3%)2761 (92.7%)2978 Open table new tab IIAbove-ankle (n=2219)AmputationNo AmputationTotalP-valueStent35 (6.3%)524 (93.7%)559.059Atherectomy17 (4.4%)368 (95.6%)385.001POBA53 (8.7%)559 (91.3%)612.650Special balloon66 (11.0%)536 (89.0%)602.009Total184 (8.3%)2035 (91.7%)2219 IIICox proportional hazards model 2219)HR95% CIP-valueAge0.9900.980 – 1.010.220Male0.7950.560 1.127.201Caucasian0.7260.507 1.041.081CHF1.2710.896 1.822.179Diabetes1.3630.852 2.160.194ESRD2.0961.433 3.004< .001Anticoagulation1.3360.914 1.935.131Re-do intervention1.6651.185 2.340.004Runoff0.6000.423 0.844.003Treatment length0.9900.970 1.010.347Atherectomy0.4970.273 0.923.026