All endovascular procedures of popliteal artery lesions (n=227) performed in 197 patients between December 2009 and January 2018 at our institution were retrospectively analyzed. The overall technical success rate was 98% and yielded 99% for stenoses (n=145) and 97% for occlusions (n=82). In a median follow-up of 10 months, the overall rate of restenosis was 23%. After 1 and 2 years, the primary patency rates were 76% and 55% and the secondary patency rate was 100%, respectively. The estimated probability of restenosis was significantly higher in stented lesions (stent vs. no stent; 36.0% vs. 19.1%; p=0.030). Multivariate analysis identified stent implantation (hazard ratio: 2.4; overall P=0.010) and diabetes (hazard ratio 2.0; P=0.023) as significant predictors for the development of restenosis. In conclusion, endovascular therapy for popliteal artery disease was associated with high technical success rates and accompanied with a promising long-term outcome, particularly in lesions treated with balloon angioplasty alone.
Table 1. Patient Characteristics (n/N (%) unless otherwise stated).
| No. of Index Interventions |
227 |
|
No. of patients |
197 |
|
Age (years) Mean ±SD |
71.9± 10.5 |
|
Sex male female |
135/197 (69) 62/197 (31) |
|
Risk factors Hypertension Hypercholesterolemia Diabetes (Ex-)smoker Family history |
184/197 (93) 169/197 (86) 79/197 (40) 123/197 (62) 58/197 (29) |
|
Comorbidities CAD Previous MI History of PTA History of Vascular Surgery Carotid artery stenosis Subclavian artery stenosis Renal artery stenosis |
135/197(69) 67/197(33) 164/197 (83) 60/197 (31) 35/197 (18) 1/197 (1) 11/197 (6) |
|
Symptoms Intermittent claudication (Fontaine II) Fontaine IIa Fontaine IIb Critical limb ischemia (Fontaine III-IV) Fontaine III Fontaine IV |
149/197 (76) 25/197 (13) 124/197 (63) 51/197 (26) 22/197 (11) 29/197 (15) |
|
Multilevel PAD |
181/197 (92) |
|
Concurrent Intervention (PTA) Iliac arteries Femoral arteries Infrapopliteal arteries |
164/197 (83) 6/197 (3) 137/197 (70) 78/197 (40) |
Abbreviations: CAD, coronary artery disease; MI, myocardial infarction; PTA, percutaneous transluminal angioplasty, PAD, peripheral artery disease.
Table 2. Lesion Characteristics (n/N (%) unless otherwise stated).
| Proximal Segment (P1) |
134/227 (59) |
|
Medial Segment (P2) |
176/227 (78) |
|
Distal Segment (P3) |
112/227 (49) |
|
Knee Joint Gap Involvement |
120/227 (53) |
|
Side Left Right |
106/227 (47) 121/227 (53) |
|
Stenosis Occlusion |
145/227 (64) 82/227 (36) |
|
Atherosclerosis |
205/227 (90) |
|
Aneurysm |
9/227 (4) |
|
Thromboembolism |
13/227 (6) |
Table 3. Procedural Characteristics (n/N (%) unless otherwise stated).
|
Arterial Access Antegrade Crossover Pedal |
170/227 (75) 57/227 (25) 1/227 (1) |
|
Success rate (overall) Stenosis Occlusion Aneurysm |
223/227 (98) 143/145 (99) 80/82 (97) 9/9 (100) |
|
PTA (POBA) DEB Stent BMS DES Self-expandable Balloon-expandable |
133/227 (59) 33/227 (15) 65/227 (29) 61/65 (94) 4/65 (6) 62/65 (95) 3/65 (5) |
|
Total Stented Length (mm) Mean ±SD |
112 ± 89.5 |
|
Max. Lesion Diameter (mm) Mean ±SD |
6.4 ± 0.9 |
|
Max. Balloon Pressure (bar) Mean ±SD |
13.4 ± 10.5 |
Abbreviations: PTA, Percutaneous Transluminal Angioplasty; POBA, Plain Old Balloon Angioplasty; DEB, drug-eluting balloon; BMS, bare-metal stent; DES, drug-eluting stent.
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