Incidence, risk factors, treatment and prognosis of popliteal artery embolization in the superficial femoral artery interventions.

Weiwei Wu,Changwei Liu,Wei Ye,Xiaojun Song,Yongjun Li,Bao Liu,Surong Hua,Yuehong Zheng

doi:10.1371/journal.pone.0107717

Abstract

ObjectivePercutaneous transluminal angioplasty and stenting (PTA + stent) has gained acceptance as a primary treatment modality for the superficial femoral artery (SFA) diseases. Popliteal artery embolization (PAE) is a severe complication in SFA interventions. The purpose of this study was to evaluate the incidence, risk factors, treatment and prognosis of PAE in primary SFA PTA + stent.MethodsChronic SFA arteriosclerosis cases that underwent primary PTA + stent were reviewed from a retrospectively maintained database. Runoff vessels were evaluated in all cases before and after the interventions for PAE detection. The primary patency, secondary patency and limb salvage rates were calculated using Kaplan-Meier analysis and compared using log-rank analysis. Cox multivariate regression was performed to evaluate predictors of patency and limb salvage rates.ResultsThere were 436 lesions treated in 388 patients with 10 PAE events (2.3%) in total. PAE rate was significantly higher in Transatlantic Inter-Society Consensus (TASC) C/D group compared with TASC A/B group (OR = 8.91, P = .002), in chronic total occlusion (CTO) lesions compared with stenotic lesions (P<.0001), and in group with history of cerebral ischemic stroke (OR = 6.11, P = .007). PAE rates were not significantly affected by age, sex, smoking, hypertension, diabetes, hyperlipidemia and runoff status. The binary logistic regression showed that only the TASC C/D was an independent predictor of PAE (P = .031). The 12-month and 24-month primary patency, secondary patency and limb salvage rates in PAE group showed no significant differences comparing with non-PAE group.ConclusionsPAE is a rare event in primary SFA PTA + stent. TASC C/D lesion, CTO and cerebral ischemic stroke history are risk factors for PAE. PAE is typically reversible by comprehensive techniques. If the popliteal flow is restored in time, PAE has no significant effect on long-term patency and limb salvage rates.

Highlights

Distal embolization (DE) of thromboembolic material generated during lower extremity endovascular intervention is a known complication following potential severe ischemic consequences [1]
Some recommend the use of a variety of embolic protection devices (EPDs) [5,6,7], while other evidence suggested that EPDs may be unnecessary [2,8]
The Popliteal artery embolization (PAE) rate was significantly higher in Transatlantic Inter-Society Consensus (TASC) C/D group compared with TASC A/B group (OR = 8.91, 95% confidence intervals (CI): 1.87–42.53, P = .002), in chronic total occlusion (CTO) lesions

Summary

Introduction

Distal embolization (DE) of thromboembolic material generated during lower extremity endovascular intervention is a known complication following potential severe ischemic consequences [1]. Clinical data have shown that the application of EPDs in lower extremity is generally safe [4]. DE rate can differ a lot in different lesion types and treatment methods. It was reported that reintervention may have a higher rate of DE, and the use of newer atherectomy devices may be more emboligenic than angioplasty with or without stenting [2]. It is still not quite sure to tell which type of lesion or treatment methods could benefit from EPDs. More retrospective or prospective studies need to be done to identify the incidence and prognosis of DE in each subgroup

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Conclusion