Impact of iliac artery calcification burden on mid-term outcomes in femoropopliteal artery disease treated with drug-coated balloon combined with provisional bare metal stenting.

OBJECTIVE

Severe arterial calcification is an important factor affecting endovascular therapy in patients with the lower extremity atherosclerotic occlusive disease. The aim of this study was to investigate whether different calcification burden of iliac artery is associated with various clinical outcomes following drug-coated balloon (DCB) combined with provisional bare metal stenting for femoral-popliteal artery disease.

METHODS

This was a retrospective cohort study of patients who underwent drug-coated balloon combined with stent placement for femoral-popliteal artery disease from January 2018 to July 2022. All patients received a computed tomography scan of the lower extremities before undergoing DCB combined with provisional bare metal stenting. The different degrees of iliac artery calcification (IAC) were evaluated using a semi-quantitative computed tomography scoring method including calcification length, circumference and morphology. The Kaplan-Meier method and Cox regression were performed to assess the correlations between calcification burden and short-to medium-term outcomes.

RESULTS

A total of 290 patients (mean age, 73.53 ± 9.64 years; 68.3 % male) were included in the study. 100 patients (34.5 %) had mild IAC scores, 96 patients (33.1 %) had moderate IAC scores, and 94 patients (32.4 %) had severe IAC scores. There were remarkable differences in the rate of 2-year primary patency and freedom from clinically driven target lesion revascularization (FCD-TLR) between the three groups (P < 0.001). The severe group indicated lower rates of amputation-free survival (AFS) compared with the mild and moderate groups (P < 0.001, respectively). Meanwhile, the severe group prompted higher rates of all-cause mortality, major amputation, and minor amputation compared with the mild and moderate group. According to stepwise multivariable cox regression analysis, severe and moderate IAC burden were linked to poor patency (HR, 2.87; 95 % CI, 1.81-4.55; HR, 1.94; 95 % CI, 1.24-3.05) and AFS (HR, 2.12; 95 % CI, 1.44-3.11; HR, 1.75; 95 % CI, 1.26-2.43).

CONCLUSIONS

Higher IAC burden is significantly correlated with lower 2-year primary patency and AFS in patients undergoing drug-coated balloon combined with provisional bare metal stenting. Consequently, a preoperative evaluation of IAC burden may aid in tailoring individualized treatment strategies.