Abstract 4426: Contemporary Below-the-Knee and Femoral-Popliteal Percutaneous Arterial Intervention: A Comparison of Procedural Outcomes and Predictors of Success - Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2 -PVI)
Background: Percutaneous vascular intervention (PVI) techniques for revascularization of symptomatic infra-inguinal peripheral arterial disease (PAD) are increasingly utilized as the preferred method of revascularization. However, the in-hospital outcomes and predictors of procedural success for both femoral-popliteal (FP) and below-the-knee (BTK) PVIs are unknown.
Methods: Data were analyzed from 10,099 consecutive PVI cases collected between 2003 through 2008 in a prospective, multi-center, multi-disciplinary regional database. Patients who underwent infra-inguinal PVI (FP or BTK) were included. Technical success was defined as completion of the PVI with <30% residual stenosis as assessed by angiography. Procedural success was defined as technical success and freedom from peri-procedural complications.
Results: A total of 5608 patients were included in the analysis, 4750 (84.7%) underwent FP PVI and 858 (15.3%) underwent BTK PVI. Patient and procedural characteristics are shown in Table 1⇓. Patients undergoing BTK PVI were more likely to receive post-PVI transfusion (6.4% vs. 8.8, p<0.001), suffer in-hospital amputation (1.7% vs. 6.2%, p<0.001), and endure contrast induced nephropathy (6.7% vs. 11.3%, p<0.0001). Multivariate predictors of procedural failure (lack of procedural success) included age ≥70 (OR 1.3, 95% CI 1.1–1.5, p=0.004), heavy vessel calcification (OR 1.3, 95%CI 1.1–1.6, p=0.004), total vessel occlusion (OR 2.8, 95%CI 2.3–3.4, p<0.0001), and BTK disease (OR 1.5, 95%CI 1.2–1.9, p=0.0003).
Conclusions: Contemporary infra-inguinal PVI is marked by high procedural success and low complication rates. Predictors of procedural failure in this cohort included advanced age, vessel calcification, total vessel occlusion and BTK disease. These data may help inform patients and clinicians when determining the optimal revascularization approach for severe infra-inguinal PAD.