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Incidence and Endovascular Treatment of Isolated Atherosclerotic Popliteal Artery Disease: Outcomes from the IPAD Multicenter Study

  • Clinical Investigation
  • Arterial Interventions
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To report the incidence and long-term outcomes following endovascular treatment of symptomatic, atherosclerotic isolated popliteal artery disease (IPAD).

Materials and Methods

This retrospective, multicenter study included all patients who underwent endovascular treatment of IPAD between January 2010 and December 2016 because of intermittent claudication or critical limb ischemia (CLI), in three tertiary University Hospitals. In total, 4717 peripheral arterial disease (PAD) procedures were analyzed. The study’s primary outcome measures were: IPAD incidence, binary restenosis rate and freedom from target lesion revascularization (TLR). Secondary outcome measures included technical success, limb salvage rate and the identification of predictors of outcomes.

Results

The incidence of IPAD was 0.98% (46/4717 PAD procedures). In total, 46 patients (38 male; mean age 73 ± 12 years) underwent plain balloon (69.5%) or bail-out stenting (30.5%) procedures. Most patients suffered from CLI (65.2%). Mean lesion length was 52.5 ± 32.0 mm and 45.6% of the cases were occlusions. Severe calcifications were noted in 26.1%. Technical success was 100%. Mean time follow-up was 32.6 ± 25.6 months. According to Kaplan–Meier analysis, restenosis was 15.8, 40.9, 45.8% and TLR-free rate was 90.5, 79.0, 74.1%, at 1, 2 and 3 years, respectively. Survival and limb salvage rates were 73.6 and 88.1%, at 5 years, respectively. The major amputation rate for CLI patients was 10.0% (3/29 limbs), while no major amputations occurred in the claudication subgroup. Cox multivariable analysis detected baseline occlusion as an independent predictor of increased restenosis (HR 5.3; 95% CI 0.21–0.66, p = 0.02).

Conclusions

Isolated popliteal lesions requiring treatment appear in nearly 1% of patients with PAD. Balloon angioplasty and bail-out stenting resulted in acceptable long-term clinical outcomes. Treatment of occlusions was correlated with increased restenosis rate.

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Authors and Affiliations

  1. Division of Interventional Radiology, 2nd Department of Radiology, School of Medicine, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece

    Stavros Spiliopoulos, Chrysostomos Konstantos, Konstantinos Palialexis, Lazaros Reppas & Elias Brountzos

  2. Department of Interventional Radiology, Patras University Hospitral, Rion, Greece

    Panagiotis Kitrou, Panagiotis Papadimatos, Konstantinos Katsanos & Dimitrios Karnabatidis

  3. Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Heraklion, Greece

    Nikolaos Galanakis, Elias Kehagias & Dimitrios Tsetis

Authors
  1. Stavros Spiliopoulos
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  2. Panagiotis Kitrou
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  3. Nikolaos Galanakis
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  4. Panagiotis Papadimatos
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  5. Konstantinos Katsanos
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  6. Chrysostomos Konstantos
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  7. Konstantinos Palialexis
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  8. Lazaros Reppas
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  9. Elias Kehagias
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  10. Dimitrios Karnabatidis
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  11. Elias Brountzos
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  12. Dimitrios Tsetis
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Corresponding author

Correspondence to Stavros Spiliopoulos.

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The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Procedural informed consent was obtained from all individual participants included in the study.

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Spiliopoulos, S., Kitrou, P., Galanakis, N. et al. Incidence and Endovascular Treatment of Isolated Atherosclerotic Popliteal Artery Disease: Outcomes from the IPAD Multicenter Study. Cardiovasc Intervent Radiol 41, 1481–1487 (2018). https://doi.org/10.1007/s00270-018-2028-7

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  • DOI: https://doi.org/10.1007/s00270-018-2028-7

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