Multicenter, retrospective registry of isolated atherosclerotic popliteal arteries treated with endovascular revascularization

Isolated atherosclerotic popliteal lesions (IAPLs) have been considered challenging. This study aimed to investigate the efficacy of endovascular therapy (EVT) using the newer devices for IAPLs. This retrospective multicenter registry analyzed patients with lower extremity artery disease having IAPLs who underwent EVT using the newer devices between 2018 and 2021. The primary outcome was primary patency 1 year after EVT. A total of 392 consecutive patients undergoing EVT for IAPLs were enrolled. The Kaplan–Meier analysis showed that the primary patency and the freedom from target lesion revascularization were 80.9% and 87.8% 1 year after EVT, respectively. The multivariate Cox proportional hazards regression analysis showed that the clinical features that were independently associated with restenosis risk were drug-coated balloon (DCB) use for younger age (< 75 years old; adjusted hazard ratio, 3.08 [95% confidence interval 1.08–8.74]; P = 0.035), non-ambulatory status (2.74 [95% confidence interval 1.56–4.81]; P < 0.001), cilostazol use (0.51 [95% confidence interval 0.29–0.88]; P = 0.015), severe calcification (1.86 [95% confidence interval 1.18–2.94]; P = 0.007), and small external elastic membrane (EEM) area measured by intravascular ultrasound (IVUS) (< 30 mm 2 ) (2.07 [95% confidence interval 1.19–3.60]; P = 0.010). From the univariate analysis, among patients treated with DCB, younger patients ( n = 141) were associated with more comorbidities including smoking ( P < 0.001), diabetes mellitus ( P < 0.001), end-stage renal disease ( P < 0.001), history of revascularization ( P = 0.046) and small EEM area ( P = 0.036), compared to older patients ( n = 140). Moreover, smaller post-procedural minimum lumen area measured by IVUS after DCB dilatation was observed in younger patients (12 ± 4 vs. 14 ± 4 mm 2 , P = 0.033). This retrospective study demonstrated that the current EVT provided an acceptable 1-year primary patency rate in patients with IAPLs. The primary patency was lower following DCB in younger patients, likely due to the higher rates of comorbidities in this patient population.