Efficacy of Cutting Balloon Angioplasty for Chronic Total Occlusion of Femoropopliteal Arteries

Abstract

Chronic total occlusion (CTO) of femoropopliteal artery (FP) continues to be a lesion subset where maintaining long-term patency after endovascular treatment is challenging. We evaluated the efficacy of cutting balloon angioplasty (CBA) for de novo FP-CTOs in patients with symptomatic lower limb ischemia. Seventy-three limbs of 67 symptomatic patients with de novo FP-CTOs successfully recanalized using CBA alone were enrolled in this study. Primary patency was defined as the absence of recurrent symptoms and no deterioration of the ankle-brachial index (ABI) >0.10 from the immediate postinterventional value. The mean age was 73.5±7.3years, and 59.7% of patients had diabetes mellitus. Most lesions were classified as Trans-Atlantic Inter-Society Consensus II type C (n=18; 24.7%) or type D (n=44; 60.3%), with mean lesion and occluded lengths of 24.8±11.4 and 17.8±11.2cm, respectively. No procedure-related adverse events occurred, except one distal embolization. The ABI significantly increased after intervention from 0.52±0.12 to 0.80±0.15 (P<0.0001), with marked improvement in clinical symptoms (Rutherford stage: 2.7±1.0 to 1.1±1.2, P<0.0001). The mean follow-up period was 31.2±18.0months, and the primary patency rates at 12 and 24months were 75.3% and 60.6%, respectively. The independent predictive factors of failed patency were baseline hemoglobin A1c (P=0.031, hazard radio [HR] 1.51 per 1%), occluded length ≥15cm (P=0.036, HR 2.90), and severe dissection (P=0.033, HR 2.85). Vessel calcification and diameter did not affect primary patency. CBA is a feasible option for endovascular treatment of FP-CTOs. Diabetic status, occlusion length, and severe dissection after CBA are independent negative predictors of long-term patency.