Long-Term Outcomes After Femoropopliteal Revascularization in Claudicants

Jul 13, 2023
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Authors:
Altin SE, Parise H, Hess CN, et al.
Citation:
Long-Term Patient Outcomes After Femoropopliteal Peripheral Vascular Intervention in Patients With Intermittent Claudication. JACC Cardiovasc Interv 2023;16:1668-1678.
Summary By:
Geoffrey D. Barnes, MD, MSc, FACC

Quick Takes

  • Four-year rates of amputation following femoropopliteal peripheral intervention for claudication was 4.3%.
  • Patients undergoing popliteal artery revascularization had the highest risk of amputation.
  • Patients undergoing combined superficial femoral and popliteal artery revascularization had the highest rate of repeat revascularization procedures.

Study Questions:

What are the 4-year amputation and revascularization rates after femoropopliteal artery peripheral vascular intervention (PVI) for patients with intermittent claudication?

Methods:

Using the PINC AI Healthcare Database, the authors identified 19,324 patients who underwent femoropopliteal PVI for intermittent claudication between 2016-2020. Patients were identified using International Classification of Diseases (ICD)-10 and Current Procedural Terminology (CPT) codes and excluded any patient with rest pain or chronic limb-threatening ischemia. Patients were categorized by the segment of PVI treatment (superficial femoral artery [SFA], popliteal artery, or both). The primary outcome was limb amputation with a secondary outcome of repeat revascularization. Statistical analysis included Kaplan-Meier estimates and Cox proportional hazard regression.

Results:

Over a median follow-up of 914 (interquartile range, 457-1,371) days, 4.3% of patients required limb amputation (95% confidence interval [CI], 4.0-4.7%). Limb amputation was more common following popliteal artery PVI than for SFA or combined popliteal and SFA PVI (7.5% vs. 3.4% vs. 5.5%, p < 0.0001). In multivariable analysis, limb amputation was more common following popliteal artery PVI than for SFA PVI (hazard ratio, 2.10; 95% CI, 1.52-2.91). Repeat revascularization rates were 15.2% overall, highest in patients undergoing combined SFA and popliteal artery PVI (18.7%) compared to SFA PVI only (13.9%) or popliteal artery revascularization only (17.1%).

Conclusions:

The authors concluded that patients with intermittent claudication undergoing femoropopliteal artery PVI had high 4-year rates of revascularization and limb amputation.

Perspective:

Peripheral artery disease (PAD) is a highly morbid condition. PVI is often offered both to relieve symptoms of claudication as well as to reduce the risk of subsequent amputation. This analysis of >19,000 patients highlights the significant residual risk that patients with PAD face when undergoing revascularization. Nearly 1 in 7 patients who undergo revascularization in the femoropopliteal artery for intermittent claudication requires a repeat revascularization procedure within 4 years. Even more concerning is that nearly 1 in 30 required amputation in that same time period. This study highlights the disproportionate burden of amputation in patients undergoing popliteal artery PVI. Further studies are needed to determine how best to reduce this risk, through improved technical offerings, medical therapies, or both.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Cardiac Surgery and Arrhythmias, Interventions and Vascular Medicine

Keywords: Amputation, Cardiology Interventions, Intermittent Claudication, Myocardial Ischemia, Myocardial Revascularization, Peripheral Arterial Disease, Popliteal Artery, Risk, Secondary Prevention, Vascular Diseases


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