The Number of Patent Tibial Vessels does not Influence Primary Patency after Nitinol Stenting of the Femoral and Popliteal Arteries

Abstract

Initial TransAtlantic Inter-Society Consensus (TASC) II classification has been shown to influence the patency of stented femoral and popliteal arteries. While several studies have shown the effect of the number of runoff vessels on the durability of infrainguinal angioplasty without stenting, the influence of tibial vessel runoff on the patency of primarily stented femoral and popliteal arteries has not been as well defined. It is the purpose of this study to determine whether the number of patent tibial vessels affects primary patency after primary stenting of the femoral and popliteal arteries. The medical records of all patients undergoing angioplasty and primary nitinol stenting of the femoral and popliteal arteries by or under the supervision of a single vascular surgeon were reviewed. Results were analyzed by the number of patent tibial vessels documented on periprocedural angiography and TASC II classification. Kaplan−Meier survival curves were plotted and differences between groups tested by log-rank method. Fisher's exact and χ2 tests were used to compare categorical factors. During a 7-year period, 316 limbs in 262 patients underwent primary stenting of the femoral and popliteal arteries. Overall primary patency was 71% at 12 months, 51.6% at 24 months, and 39.5% at 36 months. Limbs classified as TASC A or B had significantly better patency rates than those classified as TASC C or D (P < .001). While the number of runoff vessels decreased with worsening of the TASC classification (P = .024), overall (P = .355), and within individual TASC classes (P > .126 for each), there was no difference in the primary patency of stented segments with two or three patent tibial arteries and those with one or no vessels continuous to the ankle. Limbs with poor runoff (one or no vessels) were no more likely to fail with occlusion than their counterparts with two or three patent tibial vessels (P = .383). The number of patent tibial vessels at the time of initial stenting did not impact ultimate limb salvage (P = .32). The number of patent tibial vessels does not influence the primary patency of primarily stented femoral and popliteal arteries. TASC II classification would seem to be significantly more predictive of initial failure after angioplasty and stenting of these vessels.