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Outcomes After Endovascular Re-Interventions For Femoropopliteal Occlusive Disease
Venkata Vineeth Vaddavalli, M.B.B.S., Sebastian Cifuentes, M.D., Randall R. DeMartino, M.D., M.S., Jill J. Colglazier, M.D., Bernardo C. Mendes, M.D., Todd E. Rasmussen, M.D., Melinda S. Schaller, M.D., Jonathan J. Morrison, M.B.Ch.B., Ph.D., Manju Kalra, M.B.B.S., Fahad Shuja, M.B;B.S;
Mayo Clinic, Rochester, MN, USA
OBJECTIVE: Endovascular therapy for peripheral arterial disease is associated with high reintervention rates. Data on outcomes of these reinterventions are rarely reported. The aim of this study was to report primary patency, conversion to open surgical bypass and freedom from major amputations after first endovascular reintervention.
METHODS: This is a retrospective analysis of patients undergoing endovascular procedures at a single institution for femoropopliteal occlusive disease between January 2018 and July 2022. Clinical demographics, procedural details, and follow-up data were collected for patients undergoing reinterventions.
RESULTS: Two hundred sixty-five patients underwent index endovascular procedures for femoropopliteal occlusive disease during the study period. 12-month primary patency rate was 80% with 54 patients needing reintervention (20%). Four patients underwent open bypass surgery, three of whom had stenting during primary procedure. Fifty patients who underwent endovascular reintervention were analyzed. Indications for reintervention included occlusion in 22 (44%) and stenosis in 28 (56%) patients. Median time to first reintervention was 4.6 months (interquartile range [IQR]=1 to 10) and mean treatment length was 13.3 ± 9.5 cm, with a complication rate of 6%. Atherectomy or lithotripsy was utilized in 8 (16%) patients. Overall primary patency of reintervention at 12 months was 63.1%. Multiple re-interventions were performed in 16 (32%) patients. Freedom from major amputation, overall survival, and conversion to open bypass at 24 months using Kaplan-Meier analysis was 81.4%, 67.2% and 25.2%, respectively. On subgroup analyses, statistically significant difference in 12-month primary patency was found between reintervention using drug elution vs no drug elution strategy (85.5% vs 48.7%, p=0.035;
Fig. 1). Among reinterventions, there was no statistically significant difference between stenting vs stent sparing approach for 12-month primary patency (76.7% vs 48.3%), freedom from major amputation (85% vs 90.5%), and conversion to open bypass (10.4% vs 16.5%).
CONCLUSION: Endovascular reinterventions for femoropopliteal occlusive disease provide acceptable patency rates, conversion to open bypass and freedom from major amputations. Use of drug elution during reintervention is associated with superior outcomes. Stent sparing approach during reintervention did not affect the outcomes. These data suggest endovascular reinterventions should be considered first line treatment when deemed feasible.
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