Comparing Iliac Artery vs Superficial Femoral Artery Stenting in Claudicants With Respect to Long-term Outcomes and Major Adverse Limb Events

Iliac artery and superficial femoral artery (SFA) stenting are common procedures to relieve claudication, yet there is little research comparing the two in terms of patency, symptom relief, and complication rates. We hypothesized that iliac artery stenting was associated with fewer perioperative complications and equal or decreased major adverse limb events (MALE) compared to SFA stenting in patients with claudication. Utilizing data from the VQI Peripheral Vascular Intervention (PVI) registry, we identified patients who underwent either a first-time, isolated iliac artery stenting or SFA stenting for claudication. Patients with chronic limb-threatening limb ischemia, acute limb ischemia, or any prior vascular interventions were excluded. Our primary endpoint was MALE, which is comprised of loss of patency, major amputation, and target vessel reintervention. Outcomes were analyzed with χ2, independent t-test, Kaplan-Meier analysis, and Cox regression modeling. Patients were followed for an average of 383 days. Of the patients, 2250 underwent iliac artery stenting; 1374 patients underwent SFA stenting. Our study population had similar functional status and comorbidity profile, but significantly differed with respect to age, gender, race, and smoking history (Fig 1). Of note, iliac artery stenting was more common in women and the Black population. Between iliac artery and SFA interventions, the mean preoperative ankle brachial index (ABI) and postoperative ABI were not significantly different. Claudicants undergoing iliac artery stenting had a higher proportion of TASC grade 1 and 2 compared to claudicants undergoing SFA stenting (P < .001). With respect to intraoperative outcomes, iliac artery stenting demonstrated decreased fluoroscopy time (P < .001), contrast amount (P = .003), and a higher proportion of cases with a successful technical result, defined as post-procedural stenosis of < 30% (P = .026). SFA stenting was associated with higher postoperative surgical complications, most notably dissection (8.6% vs 3%; P < .001). Over the course of a year, 94% of claudicants with iliac artery interventions were free from MALE, compared to 83% for claudicants with SFA interventions (P < .001) (Fig 2). The majority of MALE were due to reinterventions, including both endovascular and open. Claudicants undergoing SFA stenting, compared to iliac artery stenting, have similar improvements in ABI, TP, and functional status, but are at greater risk of immediate postoperative complications. SFA interventions are associated with higher doses of contrast and fluoroscopy, and higher rates of 1-year MALE compared to iliac artery interventions, mainly due to higher rates of reinterventions.Table IBaseline patient characteristicsAll (N = 3624)Iliac artery stenting (n = 2250)Superficial femoral artery stenting (n = 1374)P-valueDemographics Age, years64.9 ± 0.5 [64.4, 65.4]66.8 ± 0.4 [66.4, 67.2]<.001a Gender<.001aM1345 (59.8%)905 (65.9%)F903 (40.2%)468 (34.1%) Race<.001aWhite2047 (91.0%)1167 (85.0%)Black148 (6.6%)166 (12.1%)Others5 (2.4%)40 (2.9%) BMI, kg/m227.6 ± 0.3 [27.3, 27.9]29.0 ± 0.4 [28.7, 29.3]<.001a Ambulation Status.253Ambulatory2113 (93.9%)1277 (93.0%)Ambulatory w/assistance134 (6.0%)91 (6.6%)Non-ambulatory3 (0.1%)5 (0.4%) Living status.052Home2208 (98.1%)1359 (99.0%)Rehab22 (1.0%)4 (3.3%)Nursing home20 (0.9%)10 (0.7%)Homeless0 (0%)0 (0%)Comorbidities Smoking history2124 (94.3%)1176 (85.7%)<.001a Stroke history2188 (61.9%)1344 (38.1%).423 CAD678 (30.1%)447 (32.6%).126 CHF192 (8.5%)146 (10.6%).035a COPD584 (26.0%)300 (21.8%).005a DM703 (31.2%)589 (42.9%).001a ESRD37 (1.6%)28 (2.0%).385 HTN1903 (84.6%)1208 (88.0%).004aMedications Aspirin1753 (77.9%)1116 (81.3%).015a Anticoagulation125 (5.6%)79 (5.8%).802 P2Y inhibitor (e.g. clopidogrel)636 (28.3%)541 (39.4%)<.001a Statin1638 (72.8%)980 (71.4%).353 Cilostazol6 (0.3%)1.0 (0.1%).197BMI, Body mass index; CAD, coronary artery disease; CHF, congestive heart failure; CI, confidence interval; COPD, chronic obstructive pulmonary disease; DM, diabetes mellitus; ESRD, end-stage renal disease; HTN, hypertension.Data are presented as mean ± standard error [95% CI] or number (%).aSignificance of P < .05. Open table in a new tab