Popliteal Artery Angioplasty for Chronic Total Occlusions with versus without the Distal Landing Zone

Abstract

The purpose of this study was to evaluate the outcome of percutaneous transluminal angioplasty in patients with critical limb ischemia due to popliteal artery (PA) chronic total occlusions depending on the presence of a patent portion of the PA distal to the occlusive lesion-the distal landing zone (DLZ). We retrospectively analyzed 80 patients with critical limb ischemia (all Rutherford class 5-6), who underwent percutaneous transluminal angioplasty with or without stenting for PA chronic total occlusions with no inflow disease. Baseline demographic and clinical variables, periprocedural outcome, 12-month overall survival, limb salvage, primary patency, freedom from target lesion revascularization (TLR), amputation-free survival, and freedom from major adverse limb events in DLZ versus no-DLZ lesions were assessed. Of all patients (43 men; mean age 70.2y), 40 (50%) had DLZ in the PA, whereas another 40 (50%) did not (no-DLZ). Diabetes was significantly more common among DLZ patients and was found to be a risk factor for DLZ compared with no-DLZ lesions (HR 2.58; 95% CI 1.03-6.46; P=0.04). Other demographic and clinical variables were similar between the groups. The stenting rate was 45.0% versus 42.5% in DLZ versus no-DLZ (P=1.0). At 12months, there was no significant difference in primary patency (64.7% vs. 51.6%; P=0.156), overall survival (73.4% vs. 84.0%; P=0.283), amputation-free survival (60.0% vs. 68.8%; P=0.432), and limb salvage rate (93.6% vs. 82.2%; P=0.126) between DLZ and no-DLZ groups, respectively. However, freedom from TLR (92.1% vs. 67.7%; P=0.03) and major adverse limb events (80.1% vs. 41.8%; P=0.003) was significantly higher in DLZ compared with no-DLZ lesions (92.1% vs. 67.7%; P=0.03). Diabetes was found to be a significant risk factor for DLZ compared to no-DLZ lesions. Technical success and stenting rates were similar in DLZ versus no-DLZ patients. At 12months, there was no significant difference in limb salvage, primary patency, and overall survival between the study groups. The DLZ lesions were associated with a significantly higher freedom from TLR than no-DLZ lesions.