Repeat Angioplasty and Stenting for Femoropopliteal Occlusive Disease: Factors Affecting Outcomes of the Second-Time Endovascular Intervention

Abstract

Introduction: Repeat percutaneous interventions for femoropopliteal occlusive disease are common, but the outcomes are poorly understood. We sought to determine the results of second-time femoropopliteal percutaneous transluminal angioplasty/stenting (SPTAS) and identify factors associated with outcome. Methods: A retrospective review of patients undergoing multiple percutaneous lower extremity procedures at a single institution from 2002 and 2007 identified 73 SPTAS in 73 limbs. Patient comorbidities, anatomic, and procedural characteristics were analyzed with respect to outcomes with descriptive statistics, life-table analysis, and Cox proportional hazards modeling. Patency rates were determined from the time of SPTAS. Results: Patients included 39 men (64%) and 22 women (36%) at a mean age of 70 ± 10 years. Indications included claudication in 56 limbs (77%) and critical limb ischemia in 17 (23%). Median time from the initial endoluminal intervention to SPTAS was 322 days. Twenty limbs (27%) had TransAtlantic Inter-Society Consensus II (TASCII) category D lesions; the rest were treated for TASCII A, B, and C disease. Technical success was achieved in 72 patients (99%) and initial clinical improvement in 64 (89%). During a mean follow-up of 15.3 months, 2-year primary patency, assisted primary patency, secondary patency, limb salvage, and survival were, respectively, 66% ± 8%, 86% ± 4%, 86% ± 4%, 97%, and 89%. Cox proportional hazard modeling showed that SPTAS ≤180 days of the initial endovascular intervention was the only significant predictor of failure of SPTAS primary patency (hazard ratio, 3.5; 95% confidence interval, 1.1-11). TASCII D classification was associated with failure of assisted primary and secondary patency. Conclusions: Second-time femoropopliteal angioplasty/stenting has excellent initial success but limited midterm primary patency. The need for early SPTAS is highly associated with failure of primary patency and the need for additional interventions. With vigilance, good midterm assisted primary and secondary patency in those with limited extent of disease as well as excellent limb salvage can be achieved.