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Long-term Outcome of Patients with Claudication after Balloon Angioplasty of the Femoropopliteal Arteries¹

¹ From the Departments of Clinical Radiology (T.S.J., H.I.M., P.J.M.) and Surgery (P.A.J.), Kuopio University Hospital, Puijonlaaksontie 2, 70200 Kuopio, Finland. From the 2001 RSNA scientific assembly. Received August 20, 2001; revision requested October 11; final revision received March 21, 2002; accepted April 29. Supported in part by Kuopio University Hospital (grant number 5063510), the Finnish Cultural Foundation, the Pohjois-Savo Regional Fund, the Nycomed AS Foundation, the Radiological Society of Finland, the Finnish Society of Angiology, and the Foundation of Aarne and Aili Turunen. Address correspondence to T.S.J. (e-mail: tiia.jamsen@kuh.fi).

PURPOSE: To report the long-term outcome of patients with lifestyle-limiting claudication after percutaneous transluminal angioplasty (PTA) of the femoropopliteal arteries.

MATERIALS AND METHODS: Between 1989 and 1992, 173 consecutive claudicant patients (mean age, 65 years; age range, 41–90 years) underwent PTA in 218 limbs; all interventions included femoral and/or popliteal arterial segments, and additional iliac (n = 27) and infrapopliteal (n = 11) arterial lesions were also treated. Patients were followed up for 7–10 years. Altogether, 37 (17%) limbs were classified as Fontaine class 2A, and 181 (83%) were class 2B. Average length of the primary lesion was 5.2 cm. Reinterventions were analyzed. Patency rates and patient survival were assessed by means of life table analysis. Cox-Mantel tests and Cox proportional hazards models were used to define associated independent determinants. Development of chronic critical ischemia (CCI) and its determinants was assessed by using the Pearson ² test and multiple logistic regression analysis.

RESULTS: The primary and secondary patencies (± standard error of the estimate), respectively, were 46% ± 3 and 63% ± 3 at 1 year, 25% ± 3 and 41% ± 4 at 5 years, and 14% ± 3 and 22% ± 4 at 10 years. One-third (71 of 218) of the limbs required repeat interventions, including surgical revascularization in 35 limbs. Fourteen (6.4%) limbs developed CCI, resulting in a 0.8% incidence per year. In multivariate analysis, poor postinterventional peripheral runoff was an indicator of increased risk of CCI development (P = .03).

CONCLUSION: Although the long-term patency rates of PTA of the femoropopliteal arteries in claudicant patients were poor, the acceptable number of reinterventions and the low frequency of development of CCI imply the long-term benefits achievable with this treatment.

© RSNA, 2002

Index terms: Arteries, extremities, 921.1282, 924.1282 • Arteries, femoral, 921.1282 • Arteries, popliteal, 924.1282 • Arteries, transluminal angioplasty, 921.1282, 924.1282

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