The role of femoropopliteal calcification pattern on outcomes after endovascular treatment of patients with peripheral arterial disease

INTRODUCTION: Peripheral arterial calcification is typically most prominent in the femoropopliteal (FP) segment, and its effect on endovascular treatment (EVT) processes and outcomes is poorly understood. This study aimed to evaluate the impact of the pattern of FP calcification on EVT outcomes....

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Main Authors: Gonçalo Araújo, Ricardo Correia, Tiago Ribeiro, Joana Cardoso, Helena Fidalgo, Carolina Tavares, Maria Emília Ferreira
Format: Article
Language:Portuguese
Published: Sociedade Portuguesa de Angiologia e Cirurgia Vascular 2025-04-01
Series:Angiologia e Cirurgia Vascular
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Online Access:https://acvjournal.com/index.php/acv/article/view/643
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author Gonçalo Araújo
Ricardo Correia
Tiago Ribeiro
Joana Cardoso
Helena Fidalgo
Carolina Tavares
Maria Emília Ferreira
author_facet Gonçalo Araújo
Ricardo Correia
Tiago Ribeiro
Joana Cardoso
Helena Fidalgo
Carolina Tavares
Maria Emília Ferreira
author_sort Gonçalo Araújo
collection DOAJ
description INTRODUCTION: Peripheral arterial calcification is typically most prominent in the femoropopliteal (FP) segment, and its effect on endovascular treatment (EVT) processes and outcomes is poorly understood. This study aimed to evaluate the impact of the pattern of FP calcification on EVT outcomes. METHODS: We designed a retrospective, single-center, comparative study. From January 2023 to February 2024, all patients with peripheral arterial disease who underwent EVT by a single operator as a first limb revascularization procedure for FP lesions only were considered. The calcification pattern was assessed through a qualitative fluoroscopic and angiographic evaluation. According to the degree of calcification, the patients were grouped into mild to moderate calcification (MC) and severe calcification (SC). Both groups were compared regarding the primary endpoints: reintervention rates, amputation and overall survival. RESULTS: The study included 45 patients, of which 8 (18%) presented with intermittent claudication and 37 (82%) with chronic limb threatening ischemia. The median time of follow-up was 7 months. The MC group included 71% of the patients and the SV group included 29%. The median femoropopliteal GLASS classification was 4 in both groups. No statistically significant differences were found between groups in rates of reintervention (p=0.97), amputation (p=0.86) and overall survival (p=0.45). There were two major amputations in the MC group and one in SV group after eleven months of follow-up. Higher rates of subintimal angioplasty (38% vs. 12%, p=0.048) and contralateral retrograde access (54% vs. 22%, p=0.03) were found in the SC group. CONCLUSIONS: In our cohort, highly calcified FP lesions were statistically related to contralateral retrograde access and subintimal cross-lesion pathway. However, the degree of calcification did not influence the most relevant clinical outcomes.
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spelling doaj-art-fd9cff9911df45658b5a2fda87738bdb2025-08-20T02:15:41ZporSociedade Portuguesa de Angiologia e Cirurgia VascularAngiologia e Cirurgia Vascular1646-706X2183-00962025-04-0120410.48750/acv.643The role of femoropopliteal calcification pattern on outcomes after endovascular treatment of patients with peripheral arterial diseaseGonçalo Araújo0Ricardo Correia1Tiago Ribeiro2Joana Cardoso3Helena Fidalgo4Carolina Tavares5Maria Emília Ferreira6Department of Angiology and Vascular Surgery, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, PortugalDepartment of Angiology and Vascular Surgery, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, PortugalDepartment of Angiology and Vascular Surgery, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, PortugalDepartment of Angiology and Vascular Surgery, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, PortugalDepartment of Angiology and Vascular Surgery, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, PortugalDepartment of Angiology and Vascular Surgery, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, PortugalDepartment of Angiology and Vascular Surgery, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal INTRODUCTION: Peripheral arterial calcification is typically most prominent in the femoropopliteal (FP) segment, and its effect on endovascular treatment (EVT) processes and outcomes is poorly understood. This study aimed to evaluate the impact of the pattern of FP calcification on EVT outcomes. METHODS: We designed a retrospective, single-center, comparative study. From January 2023 to February 2024, all patients with peripheral arterial disease who underwent EVT by a single operator as a first limb revascularization procedure for FP lesions only were considered. The calcification pattern was assessed through a qualitative fluoroscopic and angiographic evaluation. According to the degree of calcification, the patients were grouped into mild to moderate calcification (MC) and severe calcification (SC). Both groups were compared regarding the primary endpoints: reintervention rates, amputation and overall survival. RESULTS: The study included 45 patients, of which 8 (18%) presented with intermittent claudication and 37 (82%) with chronic limb threatening ischemia. The median time of follow-up was 7 months. The MC group included 71% of the patients and the SV group included 29%. The median femoropopliteal GLASS classification was 4 in both groups. No statistically significant differences were found between groups in rates of reintervention (p=0.97), amputation (p=0.86) and overall survival (p=0.45). There were two major amputations in the MC group and one in SV group after eleven months of follow-up. Higher rates of subintimal angioplasty (38% vs. 12%, p=0.048) and contralateral retrograde access (54% vs. 22%, p=0.03) were found in the SC group. CONCLUSIONS: In our cohort, highly calcified FP lesions were statistically related to contralateral retrograde access and subintimal cross-lesion pathway. However, the degree of calcification did not influence the most relevant clinical outcomes. https://acvjournal.com/index.php/acv/article/view/643Peripheral artery diseasecalcificationendovascularfemoropoplitealangioplasty
spellingShingle Gonçalo Araújo
Ricardo Correia
Tiago Ribeiro
Joana Cardoso
Helena Fidalgo
Carolina Tavares
Maria Emília Ferreira
The role of femoropopliteal calcification pattern on outcomes after endovascular treatment of patients with peripheral arterial disease
Angiologia e Cirurgia Vascular
Peripheral artery disease
calcification
endovascular
femoropopliteal
angioplasty
title The role of femoropopliteal calcification pattern on outcomes after endovascular treatment of patients with peripheral arterial disease
title_full The role of femoropopliteal calcification pattern on outcomes after endovascular treatment of patients with peripheral arterial disease
title_fullStr The role of femoropopliteal calcification pattern on outcomes after endovascular treatment of patients with peripheral arterial disease
title_full_unstemmed The role of femoropopliteal calcification pattern on outcomes after endovascular treatment of patients with peripheral arterial disease
title_short The role of femoropopliteal calcification pattern on outcomes after endovascular treatment of patients with peripheral arterial disease
title_sort role of femoropopliteal calcification pattern on outcomes after endovascular treatment of patients with peripheral arterial disease
topic Peripheral artery disease
calcification
endovascular
femoropopliteal
angioplasty
url https://acvjournal.com/index.php/acv/article/view/643
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