Outcomes After Endovascular Reinterventions for Femoropopliteal Occlusive Disease

Endovascular therapy for peripheral arterial disease is associated with high reintervention rates. Aim of this study was to report primary patency, conversion to open surgical bypass and freedom from major amputations after endovascular reintervention for femoropopliteal occlusive disease after index endovascular procedure.

Retrospective analysis of endovascular procedures at a single institution for femoropopliteal occlusive disease from 2015 to 2022. Subgroup analysis of the endpoints was performed based on drug elution strategy vs no drug elution strategy, and stenting vs stent sparing approach during reintervention.

621 patients underwent index endovascular procedures with a reintervention rate of 17.8% and 104 patients who underwent reintervention were analyzed. Median age was 69years and 56% were males. Median time to first reintervention was 6 months. Technical success was 97.1%. Primary patency of reintervention at 12 months was 57.3%. Freedom from major amputation, overall survival, and conversion to open bypass at 12 months was 91%, 97% and 14.7%, respectively. On subgroup analyses, primary patency at 12 month was significantly higher in drug-elution strategy compared to no drug-elution strategy (73% vs 45%, p=0.035). When stenting vs stent sparing approach were compared, there was no statistically significant difference in terms of 12-month primary patency(68.3%vs49.6%, p=0.20), freedom from major amputation(89.9%vs 92.7%,p=0.71) and conversion to open bypass(15.6%vs15.2%, p=0.57).

Endovascular reinterventions for femoropopliteal occlusive disease provide acceptable patency rates, conversion to open bypass and freedom from major amputations. Use of drug elution during reintervention is associated with superior outcomes. Stent sparing approach during reintervention did not affect outcomes.