The Results of the Endovascular Management of Femoropopliteal Arterial Occlusive Disease: A Prospective Study on 65 Consecutive Patients

Document Type : Original Article


1 Department of Vascular and Endovascular Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, IR Iran.

2 Department of Surgery, Shohada-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.

3 Department of Vascular & Endovascular Surgery, Ayatollah Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.


Background: We report the angioplasty results of patients suffering from chronic lower extremity ischemia with the involvement of femoropopliteal arteries.
Methods: Sixty-five patients were studied. All patients with lower extremity chronic ischemia resulting from femoropopliteal arterial lesions at Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran, from September 22, 2013, through March 21, 2015, were included in the study. The success of angioplasty and stenting was defined as the diminishing of the stenosis to less than 30%. A follow-up Doppler ultrasound was conducted to evaluate restenosis and reocclusion. Additionally, healing of ulcers and recovery of claudication were assessed at follow-up visits.
Results: The mean age of the study participants was 64.5±9.7 years. Forty-four patients (67.7%) were male, and 21 patients (32.3%) were female. In follow-up Doppler ultrasounds, 7 patients (10.8%) had stenosis, while 9 patients (13.8%) had occlusion, and 49 patients (75.4%) had a normal patent arterial flow. On follow-up, 53 patients (81.5%) did not report claudication. The success rate of the procedures was 98.46%. The presence of preprocedural tissue gangrene was a potential predictor of restenosis and reocclusion (P<0.05).
Conclusions: It seems that endovascular management is a feasible and effective technique in lower extremity arterial ischemia due to lesions in femoropopliteal arteries, even in subtypes TASC  C and D. (Iranian Heart Journal 2021; 22(4): 34-44)


  1. Ratnam L, Raza SA, Horton A, Taylor J, Markose G, Munneke G, Morgan R, Belli AM. Outcome of aortoiliac, femoropopliteal and infrapopliteal endovascular interventions in lesions categorized by TASC classification. Clin Radiol. 2012 Oct; 67(10):949-54. doi:10.1016/j.crad.2011.12.011.
  2. Kudo T, Chandra FA, Ahn SS. Long-term outcomes and predictors of iliac angioplasty with selective stenting. J Vasc Surg. 2005 Sep; 42(3):466-75.
  3. Powell RJ, Rzucidlo EM. Aortoiliac Disease: Endovascular Treatment. In: Sidawy AN, Perler BA (eds). Rutherford’s Vascular Surgery and Endovascular Therapy. 2019; Elsevier, Philadelphia, PA, pp. 1423-1437.
  4. Popplewell MA, Bradbury AW. Infrainguinal Disease: Endovascular Therapy. In: Sidawy AN, Perler BA (eds). Rutherford’s Vascular Surgery and Endovascular Therapy. 2019; Elsevier, Philadelphia, PA, pp. 1463-1481.
  5. Han DK, Shah TR, Ellozy SH, Vouyouka AG, Marin ML, Faries PL. The success of endovascular therapy for all TransAtlantic Society Consensus graded femoropopliteal lesions. Ann Vasc Surg. 2011 Jan; 25(1):15-24. doi:10.1016/j.avsg.2010.06.003.
  6. Tewksbury R, Pearch B, Redmond K, Harper J, Klein K, Quinn J. Outcomes of infrapopliteal endoluminal intervention for transatlantic intersociety consensus C and D lesions in patients with critical limb ischaemia. ANZ J Surg. 2014 Nov; 84(11):866-70. doi:10.1111/ans.12460.
  7. Baril DT, Marone LK, Kim J, Go MR, Chaer RA, Rhee RY. Outcomes of endovascular interventions for TASC II B and C femoropopliteal lesions. J Vasc Surg. 2008 Sep; 48(3):627-33. doi:10.1016/j.jvs.2008.04.059.
  8. Taurino M, Persiani F, Fantozzi C, Ficarelli R, Rizzo L, Stella N. Trans-Atlantic Inter-Society Consensus II C and D iliac lesions can be treated by endovascular and hybrid approach: a singlecenter experience. Vasc Endovascular Surg. 2014 Feb; 48(2):123-8. doi:10.1177/1538574413512381.
  9. Iida O, Takahara M, Soga Y, Suzuki K, Hirano K, Kawasaki D, Shintani Y, Suematsu N, Yamaoka T, Nanto S, Uematsu M. Shared and differential factors influencing restenosis following endovascular therapy between TASC (Trans-Atlantic Inter-Society Consensus) II class A to C and D lesions in the femoropopliteal artery. JACC Cardiovasc Interv. 2014 Jul; 7(7):792-8. doi:10.1016/j.jcin.2014.01.168.
  10. Yin MY, Jiang ME, Huang XT, Lu M, Lu XW, Huang Y, Li WM. Endovascular interventions for TransAtlantic InterSociety Consensus II C and D femoropopliteal lesions. Chin Med J (Engl). 2013 Feb; 126(3):415-20.
  11. Giles KA, Pomposelli FB, Spence TL, Hamdan AD, Blattman SB, Panossian H, Schermerhorn ML. Infrapopliteal angioplasty for critical limb ischemia: relation of TransAtlantic InterSociety Consensus class to outcome in 176 limbs. J Vasc Surg. 2008 Jul; 48(1):128-36. doi:10.1016/j.jvs.2008.02.027.
  12. Dearing DD, Patel KR, Compoginis JM, Kamel MA, Weaver FA, Katz SG. Primary stenting of the superficial femoral and popliteal artery. J Vasc Surg. 2009 Sep; 50(3):542-7. doi:10.1016/j.jvs.2009.04.019.
  13. Bonvini RF, Rastan A, Sixt S, Beschorner U, Noory E, Schwarz T, Roffi M, Dorsaz PA, Schwarzwälder U, Bürgelin K, Macharzina R, Zeller T. Angioplasty and provisional stent treatment of common femoral artery lesions. J Vasc Interv Radiol. 2013 Feb; 24(2):175-83. doi:10.1016/j.jvir.2012.10.020.
  14. Lee JJ, Katz SG. The number of patent tibial vessels does not influence primary patency after nitinol stenting of the femoral and popliteal arteries. J Vasc Surg. 2012 Apr; 55(4):994-1000; discussion 1000. doi:10.1016/j.jvs.2011.10.106.
  15. Park KB, Do YS, Kim DI, Kim DK, Kim YW, Shin SW, Cho SK, Choo SW, Choe YH, Choo IW. The TransAtlantic InterSociety Consensus (TASC) classification system in iliac arterial stent placement: long-term patency and clinical limitations. J Vasc Interv Radiol. 2007 Feb; 18(2):193-201.
  16. Leville CD, Kashyap VS, Clair DG, Bena JF, Lyden SP, Greenberg RK, O'Hara PJ, Sarac TP, Ouriel K. Endovascular management of iliac artery occlusions: extending treatment to TransAtlantic Inter- Society Consensus class C and D patients. J Vasc Surg. 2006 Jan; 43(1):32-9.
  17. Schönefeld E, Torsello G, Osada N, Herten M, Bisdas T, Donas KP. Long-term outcome of femoropopliteal stenting. Results of a prospective study. J Cardiovasc Surg (Torino). 2013 Oct; 54(5):617-23.
  18. Siracuse JJ, Giles KA, Pomposelli FB, Hamdan AD, Wyers MC, Chaikof EL, Nedeau AE, Schermerhorn ML. Results for primary bypass versus primary angioplasty/stent for intermittent claudication due to superficial femoral artery occlusive disease. J Vasc Surg. 2012 Apr; 55(4):1001-7. doi:10.1016/j.jvs.2011.10.128.
  19. Darling JD, McCallum JC, Soden PA, Korepta L, Guzman RJ, Wyers MC, Hamdan AD, Schermerhorn ML. Results for primary bypass versus primary angioplasty/stent for lower extremity chronic limb-threatening ischemia. J Vasc Surg. 2017 Aug; 66(2):466-475. doi:10.1016/j.jvs.2017.01.024.
  20. Aihara H, Soga Y, Mii S, Okazaki J, Yamaoka T, Kamoi D, Shintani Y, Ishikawa T; RECANALISE Registry Investigators. Comparison of long-term outcome after endovascular therapy versus bypass surgery in claudication patients with Trans-Atlantic Inter-Society Consensus-II C and D femoropopliteal disease. Circ J. 2014; 78(2):457-64.
  21. Malas MB, Enwerem N, Qazi U, Brown B, Schneider EB, Reifsnyder T, Freischlag JA, Perler BA. Comparison of surgical bypass with angioplasty and stenting of superficial femoral artery disease. J Vasc Surg. 2014 Jan; 59(1):129-35. doi:10.1016/j.jvs.2013.05.100.
  22. Papakostas JC, Chatzigakis PK, Peroulis M, Avgos S, Kouvelos G, Lazaris A, Matsagkas MI. Endovascular Treatment of Chronic Total Occlusions of the Iliac Arteries: Early and Midterm Results. Ann Vasc Surg. 2015 Nov; 29(8):1508-15. doi:10.1016/j.avsg.2015.07.011.
  23. Davaine JM, Querat J, Kaladji A, Guyomarch B, Chaillou P, Costargent A, Quillard T, Gouëffic Y. Treatment of TASC C and D Femoropoliteal Lesions with Paclitaxel eluting Stents: 12 month Results of the STELLA-PTX Registry. Eur J Vasc Endovasc Surg. 2015 Nov; 50(5):631-7. doi:10.1016/j.ejvs.2015.07.018.
  24. Ye K, Lu X, Yin M, Li W, Huang Y, Huang X, Lu M, Jiang M. Midterm outcomes of stent placement for long-segment iliac artery chronic total occlusions: a retrospective evaluation in a single institution. J Vasc Interv Radiol. 2013 Jun; 24(6):859-64. doi:10.1016/j.jvir.2013.02.038.
  25. Hassani M, Zafarghandi MR, Taghavi M, Salimi J, Moini M, Sharifi A, Noaparast M, Toubaei MR, Shahbandari M, Naserinia SA, Saadat S, Biniaz F. Two-Year Primary Patency Rates After Aortoiliac Occlusive Disease Endovascular Treatment, Iran J Radiol. 2018; 15(2):e59509. doi:10.5812/iranjradiol.59509.