Objectives: To evaluate the efficacy and prognosis of endoluminal treatment of superficial femoral artery and proximal popliteal artery chronic total occlusions.
Methods: A prospectively collected database of 148 patients (156 limbs) between January 1, 2009 and December 31, 2012 was retrospectively analysed. All the patients were treated with endoluminal interventions. The mean lesion length was (14 ± 11) cm (0.5-41.0 cm). According to Trans-Atlantic Inter-Society Consensus II (TASC II), 47 lesions were type A, 40 were type B, 26 were type C and 43 were type D. Technical success rate, clinical success rate, perioperative limb salvage rate and complication rate were evaluated. Primary patency rate, secondary patency rate, limb salvage rate and survival rate were calculated with Kaplan-Meier analysis. Cox-regression analysis was used to evaluate risk factors associated with loss of primary patency.
Results: Technical success rate was 98.7%, clinical success rate was 96.2%, perioperative limb salvage rate was 99.4%, local complication rate was 4.5% and systemic complication rate was 1.9%. At 3, 6, 12, 24 and 36 months after surgery, the primary patency rates were 95.1% ± 1.8%, 80.2% ± 3.4%, 65.6% ± 4.3%, 60.9% ± 4.6% and 53.7% ± 5.8%, respectively. The secondary patency rates were 97.9% ± 1.2%, 94.2% ± 2.0%, 89.6% ± 2.8%, 81.4% ± 3.9% and 78.0% ± 5.0%, respectively. The limb salvage rates were 99.4% ± 0.6%, 99.4% ± 0.6%, 97.8% ± 1.2%, 97.8% ± 1.2%, and 97.8% ± 1.2%, respectively. The survival rates were 99.2% ± 0.8%, 98.4% ± 1.1%, 97.5% ± 1.5%, 94.9% ± 2.3% and 91.2% ± 4.2%, respectively. TASC II C/D lesions (OR = 1.776, 95%CI 1.013~3.116) and runoff score (OR = 1.138, 95%CI 1.016-1.275) were found to be associated with loss of primary patency.
Conclusion: Endoluminal intervention was a safe and efficacious method for treating femoropopliteal artery chronic total occlusions.Satisfactory limb salvage rate can be reached despite of the high restenosis rate. TASC II C/D lesions and runoff score were found to be risk factors associated with restenosis.