Endovascular treatment for common femoral, deep femoral arteries safe, but stenting associated with poor outcomes

Endovascular interventions of the common femoral and deep femoral arteries are associated with low rates of perioperative morbidity and mortality, according to data from the Vascular Quality Initiative.

However, in those populations, stent use was associated with reinterventions and amputation, researchers reported at the Society of Vascular Surgery 2016 Vascular Annual Meeting.

Jeffrey Siracuse, MD, assistant professor of surgery and radiology, Boston University School of Medicine, and colleagues analyzed patients documented in the Vascular Quality Initiative who received endovascular treatment for peripheral artery disease isolated to the common femoral or deep femoral arteries, not including emerging or acute limb ischemia, between 2010 and 2015 (n = 1,296; mean age, 68 years; 59% men).

Jeffrey Siracuse

Among the cohort, 62.2% had claudication, 18.4% had rest pain, 19.4% had tissue loss, 27.5% received a stent and 17.7% received atherectomy, according to the researchers.

The rate of technical success was 91.7%, with complications including hematoma (4.6%), dissection (2.7%), embolization (0.7%) and perforation (0.6%).

The rate of 30-day mortality was 1.6%, the rate of 1-year survival was 93% and the rate of 3-year survival was 87%.

Siracuse and colleagues identified the following predictors of mortality:

end-stage renal disease (HR = 3.21; 95% CI, 1.86-5.55);

tissue loss (HR = 2.59; 95% CI, 1.71-3.92);

combined intervention for common femoral artery and deep femoral artery (HR = 1.88; 95% CI, 1.02-3.59);

chronic obstructive pulmonary disease (HR = 1.73; 95% CI, 1.21-2.47); and

non-ambulatory status (HR = 1.61; 95% CI, 1.09-2.38).

In those whose procedure was technically successful, the rate of freedom from loss of patency and death at 1 year was 83%. Predictors of loss of patency or death were tissue loss (HR = 2.67; 95% CI, 1.5-4.78) and non-ambulatory status (HR = 2.17; 95% CI, 1.21-3.88), according to the researchers.

At 1 year, the rate of freedom from reintervention or death was 83%, and predictors of reintervention or death were tissue loss (HR = 3.52; 95% CI, 1.86-5.55) and use of stents (HR = 1.73; 95% CI, 1.02-2.94), whereas use of P2Y12 antagonists were linked to protection from reintervention or death (HR = 0.62; 95% CI, 0.39-0.98), Siracuse and colleagues found.

The 1-year rate of amputation-free survival was 92%. Predictors of amputation or death were tissue loss (HR = 18.9; 95% CI, 7-51.5), rest pain (HR = 5.47; 95% CI, 1.76-17), prior major amputation (HR = 4.02; 95% CI, 1.65-977) and stenting (HR = 2.83; 95% CI, 1.34-5.98), the researchers reported. They found that the following characteristics were associated with amputation-free survival: aspirin use (HR = 0.42; 95% CI, 0.21-0.83) and use of P2Y12 antagonists (HR = 0.25; 95% CI, 0.13-0.5).

The researchers wrote that the 1-year patency rate for endovascular treatment in this population is lower than that for historical controls of common femoral artery endarterectomy.

“Stent use is associated with reinterventions and amputation and should be avoided if possible,” Siracuse and colleagues wrote in an abstract. “Longer-term analysis is needed to better assess durability.” – by Erik Swain

Reference:

Siracuse J, et al. William J. von Liebig Forum: SS02. Presented at: Society of Vascular Surgery 2016 Vascular Annual Meeting; June 8-11, 2016; National Harbor, Md.

Disclosure : Siracuse reports no relevant financial disclosures.