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Clinical Outcomes Of Popliteal Endovascular Revascularization In Chronic Limb Threatening Ischemia
Bryant A.K. Griffith
1, Abigail M. Petty
1, Lila D. Faulhaber, M.Ed.
1, Sara L. Zettervall, M.D., M.P.H
2, Jake F. Hemingway, M.D.
2, Kirsten D. Dansey, M.D., M.P.H
2, Matthew C. Smith, M.D., Ph.D
2.
1University of Washington School of Medicine, Seattle, WA, USA,
2University of Washington Department of Vascular Surgery, Seattle, WA, USA.
OBJECTIVES: Popliteal artery endovascular interventions have been avoided due to concerns about stent durability. This study analyzes the efficacy and durability of popliteal artery revascularization for patients with chronic limb threatening ischemia (CLTI) who were high-risk for open revascularization.
METHODS: This study is a single-site, retrospective, descriptive analysis conducted on patients who received endovascular popliteal intervention between 2017 and 2023. Preoperative, intraoperative, and postoperative characteristics were collected for 108 popliteal interventions. The primary outcome was mortality, and secondary outcomes included amputation free survival, wound healing, resolution of rest pain, and reinterventions.
RESULTS: Of 108 popliteal interventions, 84% were treated for tissue loss and 16% for rest pain. The majority of patients were white (82%), non-Hispanic (99%), and male (59%). Comorbidities included tobacco use (66%), diabetes mellitus (68%), CAD (46%), CHF (36%), COPD (25%), and dialysis dependent renal failure (11%). Of 108 interventions, 87% were performed with woven nitinol stents, 55% of which were also treated with a drug-coated ballon (DCB), while 7% were treated with DCB alone. 58% included concurrent tibial artery revascularization, and in 10%, retrograde pedal access was utilized. 30-day mortality was 7.4%, which was only observed in patients with tissue loss. The 3-year mortality rate was 25.3% and 44.0% for rest pain patients and tissue loss patients, respectively. The 30-day major amputation rate was 1.9% with a 3-year major amputation rate of 0% for patients with rest pain and 11.8% for those with tissue loss. Rest pain was resolved in 82% of patients and 77% of patients demonstrated wound healing post-intervention.
CONCLUSIONS: Popliteal endovascular intervention in high-risk patients is an effective treatment strategy for patients with wounds as well as rest pain. Overall, these findings support the use of patient-tailored revascularization strategies for CLTI patients, aligning with findings from the BEST-CLI trial and European guidelines that emphasize individualized treatment approaches and early intervention for limb salvage.
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