Endovascular management of the popliteal artery: comparison of atherectomy and angioplasty.
OBJECTIVE
Symptomatic atherosclerotic disease of the popliteal artery presents challenges for endovascular therapy. We evaluated the technical success, complications, and midterm outcomes of atherectomy and angioplasty involving the popliteal segment.


METHODS
We conducted a retrospective review of outcomes of popliteal artery intervention using atherectomy or angioplasty performed between 2003 and 2008.


RESULTS
A total of 56 patients (36% women, age 72.8 +/- 12.2 years, 77% critical limb ischemia) underwent popliteal atherectomy (n = 18) or angioplasty (n = 38). These patients had similar clinical characteristics, TransAtlantic Intersociety Consensus (TASC)/ TASC II classification, mean lesion length, and runoff scores. We observed a trend toward higher rates of technical success defined as <30% residual stenosis after atherectomy compared to angioplasty (94% vs 71%, P = .08). While angioplasty was associated with a higher frequency of arterial dissection (23% vs 0%, P = .003), atherectomy was associated with a higher rate of thromboembolic events (22% vs 0%, P = 0.01). Adjunctive stenting was used more frequently following angioplasty compared to atherectomy (45% vs 6%, P = .005). Thrombolysis was used to treat embolization in 4 patients in the atherectomy group. The improvement in the ankle-brachial index (ABI) was similar between the 2 treatment groups. Primary patency of the popliteal artery at 3, 6, and 12 months was 94%, 88%, and 75% in the atherectomy group and 89%, 82%, and 73% in the angioplasty group (P = not significant [NS]). There were no significant differences in limb salvage and freedom from reintervention at 1 year between the atherectomy and angioplasty groups.


CONCLUSIONS
Our experience with popliteal artery endovascular therapy indicates a distinct pattern of procedural complications with atherectomy compared to angioplasty but similar midterm patency, limb salvage, and freedom from intervention.
Semaan
Elie
E
Section of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston, MA 02118, USA.
Hamburg
Naomi
N
Nasr
Wael
W
Shaw
Palma
P
Eberhardt
Robert
R
Woodson
Jonathan
J
Doros
Gheorghe
G
Rybin
Denis
D
Farber
Alik
A
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation; D001157:Arterial Occlusive Diseases / Q000503:physiopathology / Q000628:therapy*; D017073:Atherectomy / Q000009:adverse effects; D050197:Atherosclerosis / Q000503:physiopathology / Q000628:therapy*; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000503:physiopathology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency