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Predictors of Crossing Failure in Femoropopliteal Lesions: The Importance of Length of the Lesion and Calcification

  • 0Department of Vascular Surgery and Endovascular Therapy, Augusta Hospital and Catholic Hospital Group Düsseldorf, Düsseldorf, Germany; Faculty of Health, University Witten/Herdecke, Witten, Germany.
Annals of Vascular Surgery +

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February 23, 2024

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February 23, 2024

View abstract on PubMed

Summary

This summary is machine-generated.

Crossing failure during endovascular therapy for peripheral artery disease is often due to lesion characteristics. Longer, calcified lesions, particularly in the femoropopliteal segment, increase the risk of crossing failure.

Area Of Science

  • Vascular Surgery
  • Interventional Cardiology
  • Medical Devices

Background

  • Endovascular therapy is the primary treatment for peripheral artery disease.
  • Technical failure, often due to inability to cross lesions with a guidewire, impacts treatment success.
  • Identifying risk factors for crossing failure is crucial for improving outcomes.

Purpose Of The Study

  • To investigate anatomical risk factors associated with guidewire crossing failure in peripheral artery disease lesions.
  • To compare characteristics of lesions that could not be crossed versus those that were successfully crossed.

Main Methods

  • Retrospective analysis of patients undergoing endovascular therapy from January 2017 to January 2022.
  • Comparison of lesion characteristics between patients with crossing failure (n=71) and successful crossing (n=142).
  • Evaluation of factors including lesion location, length, calcification (Peripheral Arterial Calcium Scoring Scale), morphology (Peripheral Academic Research Consortium, circumferential characterization), and overall complexity (Trans-Atlantic Inter-Society Consensus II classification).

Main Results

  • Patients with crossing failure had higher rates of hypertension and hyperlipidemia.
  • Significant risk factors for crossing failure included increased occlusion length, lesion length, and higher scores on the Peripheral Arterial Calcium Scoring Scale.
  • Morphological classifications (Peripheral Academic Research Consortium, circumferential characterization) were also associated with crossing failure.

Conclusions

  • Lesion calcification and length are key factors associated with crossing failure in the femoropopliteal segment.
  • The Trans-Atlantic Inter-Society Consensus II classification emerged as the most effective predictor of crossing failure.
  • These findings can help anticipate and potentially mitigate procedural challenges in endovascular interventions.