Long-term Outcomes of Primary Femoropopliteal Stents: A Retrospective Multi-Centre Experience and the Role for a Doppler Ultrasound Surveillance Programme.
Abstract
Objectives
Peripheral arterial disease (PAD) is a significant global health concern. Endovascular revascularisation is frequently used for symptom control and limb salvage in patients with femoropopliteal PAD. However, restenosis, often necessitating re-intervention, remains a challenge. This study performs a retrospective outcomes analysis to suggest which patient populations may benefit from a Doppler ultrasound (DUS) surveillance programme in improving primary patency and amputation-free survival following femoropopliteal stenting in patients with PAD.
Methods
A multicentre, retrospective cohort study was conducted using data from patients who underwent femoropopliteal stenting between January 2015 and April 2023 within a vascular network with six hospital sites. Data were collected from 238 stents in 220 patients. Demographics, stent characteristics, and surveillance protocols were analysed. Cox proportional hazards and logistic regression models were used to identify risk factors for primary patency and amputation-free survival. Kaplan-Meier survival curves were generated for both outcomes. Descriptive statistics were used to compare outcomes between supra-popliteal and infra-popliteal stents.
Results
A total of 238 stents were inserted in a population comprised of 28.6% females, with the median age of 72.5 +/- 11.5 years. In 74.8% (178) of cases, patients presented with chronic limb-threatening ischaemia (CLTI). Primary patency rates at 30 days, 6 months, 1 year, 3 years, and 5 years were 90%, 67.7%, 51.2%, 26.6%, and 11.7%, respectively. The average amputation-free survival was 3.2 years. Cox regression identified CLTI (hazard ratio, 6.37, p = .001), type 1 diabetes mellitus (hazard ratio, 3.16, p = .006), and female sex (hazard ratio, 1.69, P = .037) as significant predictors of loss of primary patency. Drug-eluting stents and diabetes were associated with poorer amputation-free survival.
Conclusions
The study illustrates a cohort of high-risk patients, particularly those with CLTI and diabetes, who may benefit from future enrolment in an enhanced DUS surveillance programme targeted to improve long-term outcomes. However, further research is required to explore the clinical-effectiveness, cost-effectiveness and implementation feasibility of such programmes in clinical practice.