Popliteal artery angioplasty for chronic total occlusions with vs without distal landing zone.

Abstract Purpose To evaluate the outcome of percutaneous transluminal angioplasty (PTA) in patients with critical limb ischemia (CLI) due to popliteal artery (PA) chronic total occlusion (CTO) depending on the presence of a patent portion of PA distal to the occlusive lesion – the distal landing zone (DLZ). Materials and methods We retrospectively analyzed 80 patients with CLI (all Rutherford class 5-6), who underwent PTA with or without stenting for PA CTO (no inflow lesions included). Baseline demographic and clinical variables, periprocedural outcome, 12-month overall survival, limb salvage, primary patency, freedom from target lesion revascularization (TLR), amputation-free survival (AFS) and freedom from major adverse limb evens (MALE)in DLZ vs no-DLZ lesions were assessed. Results Of all patients (43 men; mean age 70.2 y) 40 (50%) had DLZ in the PA, while another 40 (50%) didn't (no-DLZ). Diabetes was significantly more common among the DLZ patients and was found to be a risk factor of DLZ compared to no-DLZ lesions (HR 2.58; 95% CI 1.03-6.46; p=0.04). Other demographic and clinical variables were similar between the groups. Stenting rate was 45.0% vs 42.5% in DLZ vs no-DLZ (p=1.0). At 12 months there were no significant difference in primary patency (64.7% vs 51.6%; p=0.156), overall survival (73.4% vs 84.0%; p=0.283), AFS (60.0% vs 68.8%; p=0.432) and limb salvage rate (93.6% vs 82.2%; p=0.126) between DLZ and no-DLZ groups, respectively. However, freedom from TLR (92.1% vs 67.7%; p=0.03) and MALE (80.1% vs 41.8%; p=0.003) was significantly higher in DLZ compared to no-DLZ lesions (92.1% vs 67.7%; p=0.03). Conclusion Diabetes was found to be a significant risk factor of DLZ compared to no-DLZ lesions. Technical success and stenting rates were similar in DLZ vs no-DLZ patients. At 12 months there were no significant difference in limb salvage, primary patency and overall survival between the study groups. The DLZ lesions were associated with a significantly higher freedom from TLR than the no-DLZ lesions.