Introduction: Endovascular management of peripheral arterial disease (PAD) has become popular in the past two decades. But little is understood about the practice patterns of different endovascular treatment modalities and the factors that influence their use.
Objective: Identify predictors for stenting and atherectomy treatment, compared to angioplasty (PTA) for PAD.
Methods: We abstracted data from all endovascular procedures for PAD during January 2010- October 2016 in the Vascular Quality Initiative clinical registry. Adjusted logistic regression models built using backward elimination with a random-effects component for patient clustering were used to identify factors predictive of stenting or atherectomy compared to PTA at the artery level.
Results: Eligible patients (n=58,231) had 106,039 arteries treated (median=2, IQR=1 to 3). The majority (50%) of these arteries were treated with stents, 39% with PTA and 11% with atherectomy. Compared to PTA, those receiving stents are more likely to smoke and have iliac treatment. In atherectomy, we see more distal treatment (SFA and tibial) compared to PTA. Artery location was a significant (p<0.05) effect modifier. In multivariable models, there were no significant predictors for atherectomy; TASC C trended to significance in femoropopliteal (OR 6.6 [p=0.08]) and tibial arteries (OR 11.1 [p=0.06]). TASC C and D predicted stenting in all arteries (Figure 1). Current smoking (OR 1.49 [1.32-1.68]), obesity (OR 1.30 [1.17-1.44]), and age 70-79 (OR 1.36 [1.07-1.17]) predicted stenting in femoropopliteal arteries. These factors also predicted stenting in tibial arteries: current smoking (OR 1.40 [1.04-1.88]), obesity (OR 1.50 [1.15-1.44]), and age 80-89 (OR 1.56 [1.14-2.17]).
Conclusion: TASC C and D trended toward significance as predictors of atherectomy in tibial and femoropopliteal arteries. TASC C and D, artery type, smoking status, age, and obesity are significant predictors of stenting in all arteries.