Endovascular Management of the Popliteal Artery: Comparison of Atherectomy and Angioplasty

Section of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston, MA 02118, USA.
Vascular and Endovascular Surgery (Impact Factor: 0.66). 11/2009; 44(1):25-31. DOI: 10.1177/1538574409345028
Source: PubMed


Symptomatic atherosclerotic disease of the popliteal artery presents challenges for endovascular therapy. We evaluated the technical success, complications, and midterm outcomes of atherectomy and angioplasty involving the popliteal segment.
We conducted a retrospective review of outcomes of popliteal artery intervention using atherectomy or angioplasty performed between 2003 and 2008.
A total of 56 patients (36% women, age 72.8 +/- 12.2 years, 77% critical limb ischemia) underwent popliteal atherectomy (n = 18) or angioplasty (n = 38). These patients had similar clinical characteristics, TransAtlantic Intersociety Consensus (TASC)/ TASC II classification, mean lesion length, and runoff scores. We observed a trend toward higher rates of technical success defined as <30% residual stenosis after atherectomy compared to angioplasty (94% vs 71%, P = .08). While angioplasty was associated with a higher frequency of arterial dissection (23% vs 0%, P = .003), atherectomy was associated with a higher rate of thromboembolic events (22% vs 0%, P = 0.01). Adjunctive stenting was used more frequently following angioplasty compared to atherectomy (45% vs 6%, P = .005). Thrombolysis was used to treat embolization in 4 patients in the atherectomy group. The improvement in the ankle-brachial index (ABI) was similar between the 2 treatment groups. Primary patency of the popliteal artery at 3, 6, and 12 months was 94%, 88%, and 75% in the atherectomy group and 89%, 82%, and 73% in the angioplasty group (P = not significant [NS]). There were no significant differences in limb salvage and freedom from reintervention at 1 year between the atherectomy and angioplasty groups.
Our experience with popliteal artery endovascular therapy indicates a distinct pattern of procedural complications with atherectomy compared to angioplasty but similar midterm patency, limb salvage, and freedom from intervention.

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    • "Lejay et al. [32] reported at 1 year the infra-popliteal arteries primary patency rates and limb salvage rates for PTA were 60% and 85%, respectively. In a contrast study between PTA and atherectomy of infra-popliteal arterial occlusive disease, Semaan et al. [33] reported primary patency of the popliteal artery at 12 months were 75% and 73%, respectively, but the difference was not statistically significant. In our study, 6, 12 months primary patency rate for tibial arterial lesions with or without diabetes were 75%, 53.8% and 73.7%, 55.3%. "
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