Impact of calcification and infrapopliteal outflow on the outcome of endovascular treatment of femoropopliteal occlusive disease

Abstract

ObjectivesIn this paper, we report the long-term outcomes of the endovascular treatment of femoropopliteal occlusive disease, focusing on the importance of calcification and runoff outflow on limb salvage and patency, and the factors associated with these outcomes at a single center.MethodsThis retrospective cohort study included consecutive patients with femoropopliteal occlusive who underwent femoropopliteal angioplasty at the Division of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual, São Paulo, Brazil, between January 2015 and July 2017.ResultsIn total, 86 femoropopliteal occlusive angioplasties were performed in 86 patients, with an initial technical success rate of 95.34%. The mean ± standard deviation follow-up time was 880 ± 68.84 days. The analysis was performed at 720 days. Technical failure occurred in four patients, who were excluded from the analysis, leaving 82 patients and 82 femoropopliteal occlusive angioplasties. The estimated primary patency, secondary patency, limb salvage, and overall survival rates at 720 days were 60%, 96%, 90%, and 82.5%, respectively. In univariate and multivariate analyses, Cox regression showed worse primary patency rates in patients with one tibial vessel or isolated popliteal artery runoff (p = 0.005), calcification grade 4 (p = 0.019), calcification grade > 2 (p = 0.017), small vessel diameter < 4 mm (p = 0.03) or primary angioplasty without stenting (p = 0.021). A univariate analysis showed worse limb salvage in patients with one tibial vessel or isolated popliteal artery runoff (p = 0.039).ConclusionsIn this study, the main factors associated with worse outcomes in the endovascular treatment of femoropopliteal occlusive in terms of loss of primary patency were one tibial vessel or isolated popliteal artery runoff, calcification grade 4, or calcification grade > 2, small vessel diameter < 4 mm, and no stents use. One tibial vessel or isolated popliteal artery runoff was also associated with limb loss in a univariate Cox regression analysis.

Balloon Angioplasty of Infrapopliteal Arteries: A Systematic Review and Proposed Algorithm for Optimal Endovascular Therapy

“…7,37 Heterogeneous vessel wall calcification resists stretching forces nonuniformly, and as such some parts of the artery do not expand well, while intima and/or media dehiscence occurs at other segments. 37,70 Thus, the mechanism of postdilation dissections is due to fissuring of the intima, which eventually causes separation from the media. 26 When treating calcified infrapopliteal lesions, lumen gain occurs primarily as a consequence of some degree of dissection.…”

The catastrophic impact of COVID-19 infection in patients with chronic limb-threatening ischemia

“… 10 Similarly, in this present paper we have noticed an increase in amputations rate, higher than 50%, when compared to past papers published in our department in 2016, 2018 and 2019 (23.5%; 7.7%, 10%, 11%). 11 , 12 , 13 The possible explanations to this increased amputation rate may be related to an introduction of the lockdown in Brazil, that led to the closure of outpatient activities and prevented early observation of patients with CLTI. Patients arrived with more severe forms of CLTI, such as septic ulcers and gangrene at our vascular surgery department.…”

Association of Postangioplasty Femoropopliteal Dissections With Outcomes After Drug-Coated Balloon Angioplasty in the Femoropopliteal Arteries

“…34,35 Heterogenous vessel wall elastic properties may lead to nonuniformity dilation of the target vessel during balloon angioplasty leading to fissuring of the inner arterial wall and its separation from the outer portions of the vessel (ie, dissection). 33,36,37 As such, there is an equilibrium between forces applied for adequate acute luminal gain and the creation of dissection. EVT, including balloon angioplasty with/without stenting has been established as the main treatment strategy for femoropopliteal lesions.…”