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. 2024 Sep 16;20(18):e1154-e1162.
doi: 10.4244/EIJ-D-24-00037.

Treatment extent of femoropopliteal disease and clinical outcomes following endovascular therapy

Yong-Hoon Yoon  1 , Jae-Hwan Lee  1 , Won-Mook Hwang  1 , Hyun-Woong Park  1 , Jae-Hyung Roh  1 , Seung-Jun Lee  2 , Young-Guk Ko  2 , Chul-Min Ahn  2 , Cheol Woong Yu  3 , Seung-Whan Lee  4 , Young Jin Youn  5 , Jong Kwan Park  6 , Chang-Hwan Yoon  7   8 , Seung-Woon Rha  9 , Pil-Ki Min  10 , Seung-Hyuk Choi  11 , In-Ho Chae  7   8 , Donghoon Choi  2 , Of The K-Vis Investigators On Behalf
Affiliations

Treatment extent of femoropopliteal disease and clinical outcomes following endovascular therapy

Yong-Hoon Yoon et al. EuroIntervention. .

Abstract

Background: Endovascular therapy (EVT) has become the preferred treatment modality for femoropopliteal disease. However, there is limited evidence regarding its procedural and clinical outcomes according to the affected area.

Aims: The aim of this study is to investigate clinical outcomes and device effectiveness according to treatment extent in the superficial femoral artery (SFA), popliteal artery (PA), or both.

Methods: In this study, we analysed EVT for SFA (2,404 limbs), PA (155 limbs), SFA/PA (383 limbs) using the population in the K-VIS ELLA (Korean Vascular Intervention Society Endovascular Therapy in Lower Limb Artery Diseases) registry. The primary endpoint was target lesion revascularisation (TLR) at 2 years.

Results: The SFA/PA group exhibited a higher prevalence of anatomical complexity, characterised by long lesions, moderate to severe calcification, and total occlusion. The procedures were successful in 97.2% of SFA, 92.9% of PA, and 95.6% of SFA/PA EVTs. The 2-year TLR rates were 21.1%, 18.6%, and 32.7% in the SFA, PA, and SFA/PA groups, respectively. SFA/PA EVT was associated with a significantly increased risk for TLR compared to the SFA group (adjusted hazard ratio [HR] 1.48 [1.09-2.00]; p=0.008) and a trend towards an increased risk compared to the PA group (adjusted HR 1.80 [1.00-3.27]; p=0.052). After overlap weighting, the use of a drug-coated balloon (DCB) was shown to be beneficial, with the lowest TLR rate after SFA and SFA/PA EVT.

Conclusions: In this large real-world registry, SFA/PA EVT was associated with an increased risk for TLR at 2 years compared to the SFA or PA EVT groups, with favourable outcomes when using a DCB or drug-eluting stent in the SFA/PA EVT group.

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Conflict of interest statement

The authors have no conflicts of interest relevant to this article to declare.

Figures

Figure 1
Figure 1. Study flow.
EVT: endovascular therapy; PA: popliteal artery; SFA: superficial femoral artery
Figure 2
Figure 2. *Analysis based on patient-level data. Kaplan-Meier curves of target lesion revascularisation using overlap weighting between final treatment device groups, stratified by femoropopliteal treatment extent.
The curves represent SFA intervention (A), PA intervention (B), and combined SFA/PA intervention (C). BMS: bare metal stent; DCB: drug-coated balloon; DES: drug-eluting stent; PA: popliteal artery; PB: plain balloon; SFA: superficial femoral artery
Central illustration
Central illustration. Clinical outcomes of endovascular therapy for femoropopliteal disease over a 2-year period based on treatment extent.
*Analysis based on patient-level data. Kaplan-Meier curves for the following clinical outcomes: target lesion revascularisation (A), major amputation (B), major adverse limb event (C), and all-cause death (D). E) summarises the study results. EVT: endovascular therapy; PA: popliteal artery; SFA: superficial femoral artery
See this image and copyright information in PMC

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