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Latest from XLPAD
June 2023
Figure 1. Adjusted Kaplan‐Meier curves for freedom from MALE (A) and freedom from target limb revascularization (B) in patients with FP CTO and non‐CTO.
CTO indicates chronic total occlusion; FP, femoropopliteal; and MALE, major adverse limb events.
Clinical Perspective
What Is New?
Analysis of patient, lesion, and endovascular procedural features of femoropopliteal occlusive disease comprising chronic total occlusion (CTO) and non‐CTO lesions demonstrate that treatment of femoropopliteal CTO has been acceptable; however, lower rates of procedural success compared with non‐CTO lesions have been reported.
Patients with femoropopliteal CTO are more likely to suffer from periprocedural distal embolization and have higher rates of major adverse limb events and target lesion revascularization at 1 year.
What Are the Clinical Implications?
These findings may be considered in clinical decision making for cases involving femoropopliteal CTO.
The femoropopliteal artery constitutes the most frequent location for lower extremity peripheral artery interventions in patients with symptomatic peripheral artery disease (PAD). Moreover, nearly 40% of femoropopliteal lesions involve a chronic total occlusion (CTO).1 Endovascular treatment strategies for the femoropopliteal segment vary widely, particularly between patients with femoropopliteal CTO and those without CTO (non‐CTO).2 Although long‐segment femoropopliteal CTO (Trans Atlantic Society Classification II type C and D lesions) were previously managed primarily by surgical bypass.3 In current practice, both endovascular revascularization and surgical bypass are commonly performed as an initial treatment strategy.4, 5 Therefore, understanding procedural steps and treatment outcomes after interventions for CTO compared with non‐CTO lesions is clinically relevant. In the coronary literature, interventions involving CTO are associated with lower rates of procedural success and higher rates of major adverse cardiac events (MACE) when compared with interventions on non‐CTO lesions.6 However, no direct comparison of femoropopliteal CTO versus non‐CTO interventions has been reported, because such analyses are predicated on inclusion of lesion and procedural details that are often not available through administrative and third‐party payer databases.
Herein, we leveraged the unique features of the multicenter, core laboratory–adjudicated XLPAD (Excellence in Peripheral Artery Disease) registry to describe therapeutic approaches to femoropopliteal CTO and non‐CTO lesions and analyzed immediate and 1‐year outcomes in patients undergoing clinically indicated endovascular interventions of these lesions.
