Percutaneous Intervention for Isolated Popliteal and Tibial Occlusive Disease : Report of 213 Procedures

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Brian G. deRubertis, M.D., Robert L. Hynececk, MD, Micheal Sadek, MD, Soo J. Rhee, MD, Matthew Pierce, BS, Carissa White, B.S., James F. McKinsey, MD, Craig K. Kent, MD, Peter L. Faries, MD.
New York Presbyterian Hospital - Weill Cornell Medical College, New York, NY, USA.

Objectives. Percutaneous intervention is commonly utilized for iliac and femoral occlusive disease, and has even become a first-line modality for lower extremity revascularization in some centers. However, outcome data following intervention for popliteal and tibial intervention is limited. This report describes the results of percutaneous interventions for isolated popliteal and tibial occlusive disease.
Methods. Retrospective review of a prospectively acquired database of percutaneous popliteal and tibial interventions from 2002-2006 (claudication and limb-threat) was performed. Patency was assessed primarily by duplex ultrasonography. Patency and limb-salvage was expressed as Kaplan-Meier curves and compared by log-rank analysis.
Results. Two-hundred and thirteen interventions were performed, including 111 angioplasties , 29 angioplasties with stent placement (21 popliteal, 9 tibial), and 73 atherectomies. Mean age was 69yrs, and 55% were male. There was a high frequency of associated medical comorbidities, including HTN (87%), DM (76%), CRI (42%), ESRD/HD (14%), hypercholesterolemia (55%), CAD (49%), tobacco use (51%). Limb-threat was the presenting symptom for 80% of patients (rest pain 14.6%, tissue loss 65.3%), while the remaining 20% were claudicants. Primary & secondary patency and limb-salvage rates were 40%, 68%, and 72% at 24 months for all interventions (Figure 1). Patients treated with atherectomy were significantly more likely to present with limb-threat, which was the factor most strongly associated with reduced patency. Complications included renal dysfunction in 2.8% and minor access complications in 7.4%. Peri-operative mortality was 0.5%
Conclusion. Limb-threat is the most common indication for intervention in patients undergoing percutaneous popliteal and tibial intervention and is associated with reduced patency compared to patients presenting with claudication. Percutaneous intervention can achieve acceptable secondary patency and limb-salvage rates in these severely diseased patients.

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