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Risks and benefits of femoropopliteal percutaneous balloon angioplasty
M G Hunink1, M C Donaldson, M F Meyerovitz
1Division of Cardiovascular and Interventional Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115.
Insights
Femoropopliteal angioplasty is a safe treatment for arterial disease, offering good outcomes for claudication and stenoses. Long-term patency rates vary by lesion type and severity.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Peripheral Arterial Disease Management
Background:
- Femoropopliteal arterial disease significantly impacts patient mobility and quality of life.
- Angioplasty has emerged as a minimally invasive treatment option for these conditions.
Purpose of the Study:
- To assess the effectiveness and safety of angioplasty for femoropopliteal arterial disease.
- To identify factors influencing treatment outcomes and long-term patency.
Main Methods:
- Retrospective analysis of 126 angioplasty procedures in 131 limbs (1980-1991).
- Evaluation of 175 femoropopliteal lesions in patients with claudication or critical ischemia.
- Follow-up data analyzed for immediate success, morbidity, mortality, and long-term patency.
Main Results:
- Immediate success rate of 95% with low procedural morbidity (1.6% local, 7.1% systemic).
- Overall 5-year primary patency rate of 45%.
- Patency rates were higher for stenoses with claudication (55%) compared to critical ischemia (29%) or occlusions (36%).
Conclusions:
- Femoropopliteal angioplasty is a low-risk intervention for femoropopliteal arterial disease.
- The procedure demonstrates acceptable long-term results, particularly for patients with claudication and stenoses.
- Lesion type and indication are key predictors of long-term angioplasty failure.
Purpose:
The purpose of this study was to evaluate the efficacy of angioplasty in the treatment of femoropopliteal arterial disease.
Methods:
From 1980 to 1991, 126 angioplasty procedures were performed in 131 limbs of 106 patients with 175 femoropopliteal lesions (26 common femoral, 118 superficial femoral, and 31 popliteal). Critical ischemia was present in 55 limbs (42%), and claudication was present in 76 (58%). Angioplasty was performed for a single lesion in 87 limbs (66%) and for multiple lesions in 44 (34%). In 13 limbs (10%) the most severe lesion was an occlusion; in 118 (90%) all lesions were stenoses. Distal runoff was good (2 or 3 vessels patent) in 72 limbs (55%) and poor (0 or 1 vessel patent) in 59 (45%).
Results:
Death within 30 days occurred in 0.8%, nonfatal systemic morbidity in 7.1%, and local morbidity in 1.6% of procedures. Multivariate analysis revealed that indication and age were predictive of increased morbidity and mortality rates. Immediate success was achieved in 95% of limbs treated. Mean follow-up time was 2.0 years. The overall 5-year cumulative primary patency rate was 45% (+/- 5%). In a proportional hazards model indication and lesion type were predictive (p < 0.01) of long-term failure, with relative risks of 2.0 (1.2 to 3.3) and 2.7 (1.3 to 5.6), respectively. The 5-year primary patency rate after angioplasty for stenoses and claudication was 55% (+/- 7%), for stenoses and critical ischemia it was 29% (+/- 11%), and for occlusions it was 36% (+/- 14%).
Conclusion:
These results suggest that femoropopliteal angioplasty is a low-risk procedure with acceptable long-term results in patients with claudication and stenoses.