Outcomes of Endovascular Intervention of Atherosclerotic Lesions Confined to the Popliteal Artery

Most surgeons employ an endovascular-first approach to the treatment of peripheral arterial disease (PAD), but controversy remains regarding the best way to manage isolated popliteal artery lesions. Indeed, there is a paucity of data that compare outcomes of popliteal stents vs other catheter-based interventions (CBIs). The goal of this study was to evaluate outcomes of CBI in isolated popliteal artery lesions. The Vascular Study Group of New England (VSGNE) database was queried for all isolated popliteal artery CBIs performed for occlusive disease. Those with follow-up data available >1 year were included for analysis. The primary endpoint was 1-year freedom from a composite target lesion (TL) treatment failure that included restenosis >50% on duplex, reintervention, or ipsilateral major amputation. A total of 683 procedures performed on 627 patients from 2010 to 2021 were included. Of these, 445 (65.15%) were treated with plain balloons (POBAs), 74 (10.83%) had stents, 106 (15.52%) had special balloons (drug-coated, cutting, or lithotripsy), and 54 (7.91%) atherectomies were performed. Stent placement was associated with lower freedom from TL treatment failure (67.57%) than special balloons (83.96%; P = .01) and atherectomy (83.33%; P = .044). Stents were also associated with a higher rate of restenosis >50% when compared with POBA (9.46% vs 4.05%; P = .044) (Table). Popliteal stent placement is associated with a high rate of TL treatment failure at 1 year when compared with other CBIs and should therefore be avoided whenever feasible.TableOne-year composite target lesion (TL) outcomesStentPOBASpecial balloonAtherectomyFreedom from composite TL outcomes50 (67.57)344 (77.30)P = .0789 (83.96)P = .0145 (83.33)P = .044>50% stenosis rate7 (9.46)18 (4.05)P = .0445 (4.72)P = .2092 (3.70)P = .208Amputation rate5 (6.76)23 (5.17)P = .5752 (1.89)P = .0964 (7.41)P = .887Reintervention rate16 (21.62)70 (15.73)P = .20711 (10.38)P = .0385 (9.26) P = .062POBA, Plain balloon.Data are presented as number (%). Open table in a new tab