Endovascular management of the popliteal artery: comparison of atherectomy and angioplasty

Abstract

Purpose: Symptomatic atherosclerotic disease of the popliteal artery presents challenges for endovascular therapy. We evaluated the technical success, complications, and midterm outcomes of atherectomy and angioplasty involving the popliteal segment.

Methods: We conducted a retrospective review of outcomes of popliteal artery intervention using atherectomy or angioplasty performed between 2003 and 2008.

Results: A total of 56 patients (36% women, age 72.8 +/- 12.2 years, 77% critical limb ischemia) underwent popliteal atherectomy (n = 18) or angioplasty (n = 38). These patients had similar clinical characteristics, TransAtlantic Intersociety Consensus (TASC)/ TASC II classification, mean lesion length, and runoff scores. We observed a trend toward higher rates of technical success defined as <30% residual stenosis after atherectomy compared to angioplasty (94% vs 71%, P = .08). While angioplasty was associated with a higher frequency of arterial dissection (23% vs 0%, P = .003), atherectomy was associated with a higher rate of thromboembolic events (22% vs 0%, P = 0.01). Adjunctive stenting was used more frequently following angioplasty compared to atherectomy (45% vs 6%, P = .005). Thrombolysis was used to treat embolization in 4 patients in the atherectomy group. The improvement in the ankle-brachial index (ABI) was similar between the 2 treatment groups. Primary patency of the popliteal artery at 3, 6, and 12 months was 94%, 88%, and 75% in the atherectomy group and 89%, 82%, and 73% in the angioplasty group (P = not significant [NS]). There were no significant differences in limb salvage and freedom from reintervention at 1 year between the atherectomy and angioplasty groups.

Conclusions: Our experience with popliteal artery endovascular therapy indicates a distinct pattern of procedural complications with atherectomy compared to angioplasty but similar midterm patency, limb salvage, and freedom from intervention.

Figure 1

Effect of endovascular treatment with angioplasty or atherectomy on ABI. As shown, in both groups ABI was higher after treatment (*P<0.001). There were no differences in baseline ABI (P=0.82) or the magnitude of increase in ABI (P=0.63) following intervention between atherectomy and angioplasty groups.

Figure 2

Kaplan-Meier analysis of freedom from reintervention for the atherectomy (ATH) and angioplasty (ANG) groups (P=0.592).

Figure 3

Kaplan-Meier analysis of Primary Patency for the atherectomy (ATH) and angioplasty (ANG) groups (P=0.286).

Appendix 1. Distribution of Additional Vessels Treated

Number of additional vessels treated in various arterial segments. EIA, external iliac artery, CFA, common femoral artery, SFA, superficial femoral artery, Tibial, includes tibioperoneal trunk, anterior tibial, peroneal, and posterior tibial arteries.

Appendix 2

Kaplan-Meier analysis of Survival for the atherectomy (ATH) and angioplasty (ANG) groups (P=0.759).

Appendix 3

Kaplan-Meier analysis of limb salvage (LS) for the atherectomy (ATH) and angioplasty (ANG) groups (P=0.141).