Prolonged high-pressure balloon angioplasty of femoropopliteal lesions: Impact on stent implantation rate and mid-term outcome

Abstract

Objectives: To assess the impact on stent implantation rate and mid-term outcomes of prolonged high pressure angioplasty of femoropopliteal lesions.

Methods: We retrospectively enrolled 620 consecutive patients from January 2011 to December 2011 (75.6 ± 12.3 years, 355 males, 76.5% in Rutherford class 5-6), referred for critical limb ischemia and submitted to prolonged high-pressure angioplasty of femoropopliteal lesions. The definition of prolonged high-pressure angioplasty includes dilation to at least 18 atm for at least 120 s. Procedural data, and clinical and instrumental follow-up were analyzed to assess stent implantation rate and mid-term outcomes.

Results: The preferred approach was ipsilateral femoral antegrade in 433/620 patients (69.7%) and contralateral cross-over in 164/620 (26.4%) and popliteal retrograde + femoral antegrade in 23/620 (3.7%). Techniques included subintimal angioplasty in 427/620 patients (68.8%) and endoluminal angioplasty in 193/620 patients (31.2%). The prolonged high pressure balloon angioplasty procedure was successful in 86.2% (minor intra-procedural complications rate 15.7 %), stent implantation was performed in 74 patients (11.9%), with a significant improvement of ankle-brachial index (0.29 ± 0.6 vs. 0.88 ± 0.3, P < 00.1) and Rutherford class (5.3 ± 0.8 vs. 0.7 ± 1.9, P < 0.01), a primary patency rate of 86.7%, restenosis of 18.6 % on Doppler ultrasound and a target lesion revascularization of 14.8% at a mean follow-up of 18.1 ± 6.4 months (range 1-24 months). Secondary patency rate was 87.7%.

Conclusions: Prolonged high pressure angioplasty of femoropopliteal lesions appears to be safe and effective allowing for an acceptable patency and restenosis rates on mid-term.

Keywords: Angioplasty; Balloon; Peripheral artery disease; Stent.

Figure 1.. Prolonged high-pressure angioplasty in a non calcified lesion.

(A): Baseline digital angiography in a 76-year old man with severe claudication demonstrating a long occlusion of the superficial femoral artery; (C): angiographic result after prolonged high pressure angioplasty with a Mustang balloon (B).

Figure 2. Prolonged high-pressure angioplasty in a severely calcified lesion.

(A-B): Baseline digital angiography in a 73-year old woman with severe coronary disease and ischemic heart cardiomyopathy and severe claudication demonstrating a long calcified occlusion of the superficial femoral and popliteal arteries; (E-F): angiographic result after prolonged high pressure angioplasty with a Dorado balloon (C-D).