Impact of Race on Infrainguinal Angioplasty and Stenting

Abstract

Over the last decade, catheter-based interventions on lower extremity arteries have been used with increasing frequency. However, the effect of racial background on the outcome of lower extremity endovascular interventions for peripheral arterial disease is unknown. The purpose of this study was to determine the effect of patients' race on the durability of angioplasty and stenting performed on the superficial femoral and popliteal arteries. The records of all patients undergoing percutaneous intervention on the lower extremity arteries during a 14-year period were reviewed. During a 44-month period (2003-2007), all patients underwent primary stenting as part of a prospective study protocol. Indication for intervention, TransAtlantic InterSociety Consensus II classification, runoff anatomy, site of intervention, and the placement of stents were noted. Results were analyzed by race. Kaplan-Meier life survival curves were plotted and differences between groups tested by log-rank method. Cox proportional hazards regression model was used to perform the multivariate analysis. Between 1994 and 2007, a total of 374 percutaneous interventions were performed on the superficial femoral and popliteal arteries in 280 patients. Of these, 182 procedures were angioplasties and 192 included both angioplasty and stenting. The study group consisted of 60% Caucasians, 23% Hispanics, 12% African Americans, and 5% Asians. No difference in primary patency rates was noted between individuals belonging to different races. However, in those undergoing angioplasty alone, Caucasians had the highest rate of failure, followed by Hispanics, African Americans, and then Asians (p < 0.002). No difference in patency rates between races was seen in patients undergoing angioplasty with stenting. For the entire group, dyslipidemia, TransAtlantic InterSociety Consensus II C and D lesions, and angioplasty without stenting negatively affected primary patency. Race does not appear to influence the durability of catheter-based procedures performed on the superficial femoral and popliteal arteries. However, in patients who underwent angioplasty alone, it was noted that Caucasians had the highest rates of failure and Asians the lowest. However, this difference was no longer apparent when stents were used.