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

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.