Clinical outcomes following invasive treatment of femoropopliteal artery disease: a retrospective single-center cohort study.

To identify predictors of clinical success in invasive treatment for femoropopliteal disease aiding clinical decision-making. A retrospective analysis was performed on 676 consecutive patients who underwent a first episode of invasive treatment for femoropopliteal disease, either endovasular therapy (EVT) or femoropopliteal bypass (FPB), between 2004 and 2015. Primary endpoints were primary and secondary clinical patency and amputation rate. Kaplan-Meier curves were used to evaluate clinical patency. A Cox proportional hazard model explored predictors of primary endpoints. Most patients (58%) underwent EVT as primary intervention, while 42% underwent FPB. Median follow-up was 43 months. The only independent predictor for loss of primary clinical patency was critical limb-threatening ischemia (CLTI) (P=0.008, HR 1.25; 95% CI 1.07 to 1.47). Secondary clinical patency was positively associated with FPB surgery (P=0.037, HR 0.66; 95% CI 0.44 to 0.97), a higher pre-interventional ankle-brachial index (ABI) (P=0.029, HR 0.43; 95% CI 0.20 to 0.92), more distal runoff vessels (P=0.036, HR 0.77; 95% CI 0.60 to 0.98) and the absence of ischemic heart disease (P=0.006, HR 1.69; 95% CI 1.16 to 2.47). In CLTI patients, chronic renal failure predicted loss of primary and secondary clinical patency and increased amputation risk. In this cohort, CLTI was independently associated with decreased primary clinical patency in invasive treatment for femoropopliteal disease. Secondary clinical patency was positively associated with FPB, higher ABI, more runoff vessels and the absence of ischemic heart disease.

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