2-Year outcomes of endovascular therapy of popliteal artery restenosis

Summary: Background: To assess the mid-term outcome of endovascular treatment for popliteal artery restenosis. Patients and methods: This retrospective study included patients with peripheral artery disease (Rutherford class (RC) 2–5) and popliteal artery restenosis treated between January 2007 and December 2017. Patients were classified into four groups based on lesion extent: isolated popliteal lesions and lesions extending to femoral and/or below-the-knee arteries (BTK). The primary endpoint was target lesion revascularization (TLR) at 12 months. Secondary endpoints included TLR at 24 months, changes in RC, ankle-brachial index (ABI), amputation and mortality rates. Results: A total of 332 patients were analyzed. Ninety-two patients received popliteal treatment only (group I), in 81 patients lesion extended into the femoral artery (group II), 112 lesions extended into the BTK arteries (group III), and 47 lesions involved both, femoral and BTK arteries (group IV). At 12 months, the overall TLR rate was 34.6%, with no significant differences between subgroups. Drug-coated balloon (DCB) angioplasty showed a significant benefit during the first 12 months (p = .035), but this advantage was not sustained thereafter (p = .798). TLR rates did not differ significantly between patients treated with stent angioplasty and those without stenting (p = .087). Significant improvements in ABI and RC were observed in all groups. Major amputation rates were 0.9% at 12 months and 1.8% at 24 months. Mortality rates were 1.5% and 7.5%, respectively. Conclusions: Reintervention rate after endovascular treatment of popliteal artery restenosis is high. The potential benefits of drug-coated balloon angioplasty and stent angioplasty require further clarification through prospective studies.