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

Objective Most surgeons employ an endovascular first approach to the treatment of peripheral arterial disease (PAD), but controversy remains regarding the ideal interventions for the management of isolated popliteal artery disease (IPAD). Indeed, there are a paucity of data that compare outcomes of popliteal stents versus other peripheral vascular interventions (PVI). The goal of this study was to evaluate outcomes of PVI in IPAD. Methods The Vascular Study Group of New England database was queried for all IPAD PVI performed for atherosclerotic occlusive disease from 2010-2021. Those with at least one year of follow-up data available were included for analysis. The primary endpoint was one-year freedom from a composite target lesion (TL) treatment failure that included re-stenosis >50% on duplex, re-intervention, or ipsilateral major amputation. Results We included 689 procedures performed on 634 patients. 250 (36.3%) were treated with plain balloons (POBA), 215 (31.2%) had stents, 170 (24.7%) had special balloons (drug-coated, cutting, or lithotripsy), and 54 (7.8%) atherectomies were performed. Stent placement was associated with lower freedom from TL treatment failure (72.6%) than special balloon (81.2%, p=0.048) and atherectomy (88.9%, p=0.012), but not POBA (76.8%, p=0.293). On multivariable logistic regression, stents (OR 0.637, p=0.021) and pre-operative P2Y12 inhibitor therapy (OR 0.683, p=0.048) were both associated with lower freedom from intervention failure. Conclusion Popliteal stent placement is associated with a higher rate of TL treatment failure at 1 year when compared with other PVI including special balloon angioplasty and atherectomy, but not POBA, and should therefore be avoided in favor of special balloons or atherectomy whenever feasible.