Long-term Outcomes of Patients Undergoing Endovascular Infrainguinal Interventions with Single Vessel Peroneal Artery Runoff

Objective(s): Peroneal artery-only runoff (PAOR) has traditionally been associated with inferior results after lower extremity revascularization. Recent reports have shown promising early results after endovascular revascularization (PTA/stent) of patients with PAOR, although the long-term results are unknown. The purpose of this study was to evaluate the effect of PAOR on long-term primary patency (PP) and limb salvage (LS) after PTA/stent.
Methods: From January 2002 to December 2007, 869 patients with ≥1 runoff vessel underwent PTA/stent. There were 317 patients with single vessel runoff that comprised the study cohort. Endpoints included PP, assisted patency (AP), LS and survival. Long-term outcomes were determined by Kaplan-Meier life-table and multivariate Cox regression analyses.
Results: There were 104 PAOR and 213 patients with posterior or anterior tibial artery runoff (non-PAOR). PAOR were more likely to present with critical limb ischemia (100% vs. 46%, P<.0001). Significant clinical and demographic differences are summarized in Table I. Median follow-up was 33 months (range 0-75 months). PAOR was associated with decreased 5-year PP (26±6.8 vs. 44±5.0%, P=.04), and survival (38±7.1 vs. 63±4.4%, P=.01) compared to non-PAOR. However, there was no difference in AP (P=.77) or limb salvage (P=.23). Only critical limb ischemia was associated with poor primary patency (OR 1.78; 95% CI [1.23-2.58]; P=.002) and limb salvage (OR 6.29; 95% CI [1.91-20.83]; P=.003) on Cox regression multivariate analysis. PAOR was not an independent predictor of any outcome on multivariate analysis.

Conclusions: Patients with PAOR have decreased long-term primary patency after PTA compared to patients with non-PAOR, likely due to a more severe clinical presentation. Despite this, patients with PAOR can achieve comparable assisted patency and limb salvage rates with close surveillance and reintervention.