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Patterns of Femoropopliteal Recurrence After Endoluminal Therapy: Does Routine Stenting of the Entire Diseased Artery Decrease the Incidence of Clinically Significant Recurrence?
Misaki Kiguchi, MD, MBA, Luke Marone, MD, Rabih Chaer, MD, Justine Kim, Zhen Yu Shi, MD, Rolando Celis, MD, Michel Makaroun, MD, Robert Rhee, MD.
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Objective: To determine the incidence and characteristics of recurrent disease after femoropopliteal angioplasty, following either selective or routine stenting of diseased site(s).
Methods: Retrospective analysis of a prospectively maintained database for femoropopliteal interventions from 6/03 to 7/10 was performed. Interventions during this period were from a single institution, followed at 1, 3 and 6 months after initial intervention and on a semiannual basis thereafter with clinical examination and duplex ultrasound. Two groups were identified, Group RS (all diseased areas are routinely stented) versus Group SS (selective stenting for only segments which exhibited compromised flow from residual stenosis or significant dissection). Those patients who developed recurrent symptoms (claudication, rest pain, etc.), decrease in ABI (>0.2), or duplex documentation of a significant (> 80%) recurrent stenosis, underwent reintervention. Patient demographics, co-morbidities, TASC II classification, run off, and degree of calcification (none, mild, moderate, severe) at initial intervention were recorded. Time to re-intervention and recurrence pattern were recorded for both groups.
Results: 746 endovascular interventions in 447 patients were performed during the study period. Total recurrence rate, including bypass, amputation, and asymptomatic occlusion after initial intervention, was 36.48 % (Group SS = 42.9% Group RS 33.1% p= 0.04). Of all initial interventions, 182 endovascular re-interventions in 165 patients for recurrent femoropopliteal disease were identified (Group SS=70, Group RS=95). No differences were noted among the groups in terms of gender, comorbidities, initial TASC II classification, run off, calcification scores, or statin/clopidrogel use. Time to recurrence was not different between the RS and SS groups. TASC II classification, run off score, and degree of calcification were not different between the two groups (Table 1). Although not statistically significant, analysis of recurrence pattern demonstrated denovo stenosis was more common in the SS group (50.0% vs. 34.7% p=0.06).
Table 1
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Group SS
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Group RS
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p-value
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n=70
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n=95
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Recurrence time (in days)
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245.5 (18-1078)
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289.0 (27-2022)
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0.07
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TASC
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A
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18/69 (26.1%)
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17/94 (18.1%)
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0.41
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B
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17/69 (24.6%)
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33/94 (35.1%)
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C
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13/69 (18.8%)
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19/94 (20.2%)
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D
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21/69 (30.4%)
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25/94 (26.6%)
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Recurrence pattern
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prior intervention site
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58/70 (82.9%)
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76/95 (80.0%)
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0.69
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marginal
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18/70 (25.7%)
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36/95 (37.9%)
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0.13
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denovo
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35/70 (50.0%)
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33/95 (34.7%)
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0.06
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Runoff
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good
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30/70 (42.9%)
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46/95 (48.4%)
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0.59
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compromised
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29/70 (41.4%)
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32/95 (33.7%)
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poor
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11/70 (15.7%)
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17/95 (17.9%)
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Calcification
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none
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6/70 (8.6%)
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12/95 (12.6%)
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0.51
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mild
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30/70 (42.9%)
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34/95 (35.8%)
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moderate
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22/70 (31.4%)
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37/95 (39.0%)
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severe
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12/70 (17.1%)
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12/95 (12.6%)
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Conclusion: Patients treated with selective stenting had no difference in time to recurrence and recurrence pattern compared to routine stenting.
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