Predictors of immediate residual stenosis after standardized balloon angioplasty for superficial femoral artery lesions

Aim: Residual stenosis after superficial femoral artery (SFA) balloon angioplasty may adversely affect immediate procedural success and long-term patency. This study aimed to identify clinical, angiographic, and procedural factors associated with immediate residual stenosis following SFA balloon angioplasty performed according to a standardized balloon inflation protocol.

Material and Methods: This retrospective single-center observational cohort study included 167 consecutive patients who underwent primary SFA balloon angioplasty between January 2024 and April 2026. All procedures were performed using routine predilatation followed by a standardized 2-minute balloon inflation protocol. Residual stenosis ≥ 30% on postprocedural digital subtraction angiography (DSA) was defined as a suboptimal immediate angiographic outcome. Clinical, angiographic, and procedural variables were evaluated, and independent predictors were identified using multivariable logistic regression analysis. Only Trans-Atlantic Inter-Society Consensus II (TASC II) A and B lesions were included.

Results: Residual stenosis ≥ 30% was observed in 70 patients (41.9%). Compared with patients who achieved an optimal angiographic result, those with residual stenosis were older, had a higher prevalence of diabetes mellitus, and exhibited more severe preprocedural stenosis. Lesion length did not differ significantly between patients with residual stenosis < 30% and ≥ 30% (91.3 ± 21.8 mm vs 88.1 ± 20.4 mm; p = 0.333). Multivariable logistic regression demonstrated that increasing age (odds ratio (OR), 1.05; 95% confidence interval (CI), 1.01 – 1.09; p = 0.026), diabetes mellitus (OR, 2.67; 95% CI, 1.27 – 5.59; p = 0.009), and greater preprocedural stenosis severity (OR, 1.11; 95% CI, 1.06 – 1.15; p<0.001) were independently associated with residual stenosis. Lesion length was not an independent predictor (p = 0.344). The final prediction model demonstrated good discriminatory performance (area under the receiver operating characteristic curve (AUC) = 0.80).

Conclusion: Advancing age, diabetes mellitus, and greater preprocedural stenosis severity were independent predictors of residual stenosis after standardized balloon angioplasty for TASC II A-B SFA lesions, whereas lesion length was not. Early identification of patients at increased risk of residual stenosis may facilitate individualized procedural planning and optimize immediate angiographic outcomes.