Tibial Artery Stenting in the VQI Database

The development of dedicated tibial artery stents has been challenging despite reports of successful use of coronary stents in the infrapopliteal circulation. This study compares the outcomes of tibial stenting and plain balloon angioplasty (POBA) prior to FDA approval of a tibial scaffold.

The Vascular Quality Initiative (VQI) Peripheral Vascular Intervention module was reviewed for patients treated for tibial peripheral arterial disease (PAD) between 2011-2024. Trends in tibial interventions were derived, and patient characteristics undergoing stenting or POBA were compared. Propensity score matching was performed to evaluate outcomes, and Kaplan-Meier (KM) estimates of Major Adverse Limb Event-free (MALE-free) survival were compared.

Among 316,240 patients undergoing 460,584 procedures, 90,380 (28.6%) underwent tibial revascularization. Use of stenting declined (11.7%→3.0%), while special balloons increased (2.7%→14.3%). Before matching, patients undergoing stenting were more likely to be older, male, White, and had higher smoking rates but were less likely to have diabetes, congestive heart failure, and end-stage renal disease compared to patients undergoing POBA. They also more frequently underwent elective treatment of shorter lesions involving the tibioperoneal trunk with more fluoroscopy time. After matching, patients undergoing stenting had higher perioperative complications but achieved higher technical success compared to POBA. After a mean follow up of 1.2-years, KM analysis demonstrated superior MALE-free survival among patients receiving stenting.

Tibial stenting is associated with higher technical success than POBA and superior MALE-free survival. Dedicated tibial artery stents are needed in the endovascular armamentarium.