Mid-term survival and amputation-free survival following endovascular intervention
Keywords:
chronic limb-threatening ischemia, peripheral arterial disease, critical ischemia, digital subtraction angiography, chronic kidney disease, acute myocardial infarctionAbstract
Chronic limb-threatening ischemia (CLTI) is associated with a high risk of amputation and mortality, while the effectiveness of infrapopliteal endovascular revascularization remains a subject of debate. The aim of this study was to evaluate clinical outcomes following endovascular recanalization in patients with limb-threatening ischemia. A total of 136 patients were followed over a 12-month period. Endpoints included overall survival, amputation-free survival, primary and assisted primary patency, and rates of restenosis and reintervention. The one-year survival rate was 89.0%, and the amputation-free survival rate was 88.6%. Limb salvage was achieved in 94.6% of patients. Primary patency was 57.6%, and assisted primary patency was 61.3%. Restenosis was observed in 36% of cases, and reinterventions were required in 26.2%. Independent predictors of adverse outcomes included age over 80 years, chronic kidney disease, congestive heart failure, TASC D lesions, and the inability to perform surgical bypass. Endovascular revascularization provides high rates of limb salvage despite moderate patency and a significant incidence of restenosis.
References
Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45(Suppl S):S5–S67.
Jamieson C. The definition of critical ischaemia of a limb. Br J Surg. 1982;69(Suppl):S1–S2.
Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery/North American Chapter, International Society for Cardiovascular Surgery. Suggested standards for reports dealing with lower extremity ischemia. J Vasc Surg. 1986;4(1):80–94.
Rutherford RB, Baker JD, Ernst C, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg. 1997;26(3):517–538.
Dormandy JA, Rutherford RB; TASC Working Group. Management of peripheral arterial disease (PAD). J Vasc Surg. 2000;31(1 Pt 2):S1–S296.
Abu Dabrh AM, Steffen MW, Undavalli C, et al. The natural history of untreated severe or critical limb ischemia. J Vasc Surg. 2015;62(6):1642–1651.e3.
Spreen MI, Martens JM, Knippenberg B, et al. High and immeasurable ankle-brachial index as predictor of poor amputation-free survival in critical limb ischemia. J Vasc Surg. 2018;67(1):157–165.
Bird CE, Criqui MH, Fronek A, et al. Quantitative and qualitative progression of peripheral arterial disease by non-invasive testing. Vasc Med. 1999;4(1):15–21.
Fowkes FG, Lowe GD, Housley E, et al. Cross-linked fibrin degradation products, progression of peripheral arterial disease, and risk of coronary heart disease. Lancet. 1993;342(8881):84–88.
Kennedy M, Solomon C, Manolio TA, et al. Risk factors for declining ankle-brachial index in men and women 65 years or older: the Cardiovascular Health Study. Arch Intern Med. 2005;165(16):1896–1902.
Valentine RJ, Hansen ME, Myers SI, et al. Intermittent claudication caused by atherosclerosis in patients aged forty years and younger. Surgery. 1990;107(5):560–565.
Levy PJ, Gonzalez MF, Hornung CA, et al. A prospective evaluation of atherosclerotic risk factors and hypercoagulability in young adults with premature lower extremity atherosclerosis. J Vasc Surg. 1996;23(1):36–45.
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