Abstract 16711: Contemporary Treatment and Outcomes of Peripheral Vascular Interventions for Symptomatic Lower Extremity Peripheral Arterial Disease: Insights From the National VA Clinical Assessment, Reporting and Tracking (VA-CART) Program Peripheral Registry
Background: The numbers of peripheral vascular interventions (PVI) have exploded over the last decade. The contemporary indications, treatments and outcomes in clinical practice are not well defined.
Methods: We studied a convenience sample of 358 patients treated in 33 VA catheterization laboratories between August 2005 and August 2010. Patients were stratified by their PVI indication: Claudication vs. Critical limb ischemia (CLI). Kaplan-Meier curves were constructed and Cox proportional hazards analysis was performed to identify independent predictors of follow-up amputation and mortality.
Results: The median follow-up was 2.37 years, the mean age was 64.9 +/- 8.7 years, and 97.8% have a history of hypertension. Of the 358 patients, 71 (19.8%) underwent PVI for CLI. The superficial femoral artery was the most common target lesion for both claudicants (41.2%) and CLI patients (46.7%). Self expanding stents (46.7%) were the most common treatment strategy for patients with claudication whereas angioplasty (34.7%) was the most common stand alone treatment in CLI patients. Three year survival for patients treated for claudication versus CLI was 89.4 ± 2.4% and 67.3 ± 7.2% respectively (log-rank p<0.001) (Figure). Independent predictors of follow-up mortality included age (hazard ratio[HR], 1.05; 95% CI, 1.02 to 1.08; P<0.001), diabetes mellitus (HR, 2.52; 95% CI, 1.21 to 5.24; P=0.013), and CLI as an indication (HR, 2.54; 95% CI, 1.36 to 4.75; P=0.004). Three year amputation rates for patients treated for claudication or CLI was 1.7 ± 0.9% and 13.8 ± 4.6% respectively (log-rank p<0.001). CLI was a strong independent predictor of amputation (HR, 10.0; 95% CI, 3.0 to 33.3; P<0.001) (Figure).
Conclusions: Contemporary follow-up mortality and amputation rates in patients undergoing PVI for critical limb ischemia are high, approaching 1 in every 3 patients for mortality and 1 in every 8 patients needing amputation at 3 years.
- © 2011 by American Heart Association, Inc.