Long-Term Outcomes and Major Adverse Limb Events in Claudicants Undergoing Iliac Artery Stenting versus Superficial Femoral Artery Stenting.

BACKGROUND: Iliac artery and superficial femoral artery (SFA) stenting are common procedures to relieve claudication. We investigate major adverse limb events (MALE), follow-up symptoms and perioperative complications between the 2 interventions.

METHODS: Utilizing the Vascular Quality Initiative (VQI) Peripheral Vascular Intervention registry, we identified patients undergoing a first-time, isolated iliac artery or SFA stenting for claudication from 2010 to 2022. Patients with chronic limb threatening limb ischemia, acute limb ischemia, or prior interventions were excluded. Our primary end point was MALE, comprised of patency loss, major amputation, and target vessel reintervention. Outcomes were analyzed with Kaplan-Meier analysis and Cox regression modeling.

RESULTS: A total of 2,250 patients underwent iliac artery stenting; 1,374 patients underwent SFA stenting. Intraoperatively, iliac artery stenting demonstrated decreased fluoroscopy time (17.1 vs. 21.7 min, P < 0.001), decreased contrast usage (118 vs. 125 mL, P = 0.003), and lower rates of dissection (8.6% vs. 3.0%, P < 0.001). Ninety-four percent of claudicants with iliac stenting were free from MALE at 1-year, compared to 83% of claudicants with SFA stenting (P < 0.001), predominantly due to reinterventions. On multivariable Cox regression analysis, SFA stenting was most strongly associated with MALE (hazard ratio: 2.96 [95% confidence interval: 2.16, 4.04], P < 0.001). On long-term follow-up, there was no difference in the proportion of patients with claudication symptom resolution (P = 0.469).

CONCLUSION: Claudicants undergoing SFA interventions have higher rates of perioperative complications and 1-year MALE compared to iliac artery interventions, despite no differences in long-term symptom resolution.