Abstract 13627: Long-term Clinical Efficacy of Endovascular Therapy for Patients with Critical Limb Ischemia due to Pure Isolated Infrapopliteal Lesions
Background: The prognostic outcomes of endovascular therapy (EVT) for isolated infrapopliteal lesions remain to be adequately studied. Objectives: We investigated and risk-stratified long-term prognosis after EVT for critical limb ischemia (CLI) due to isolated infrapopliteal lesions.
Methods: Between March 2004 and October 2010, 1057 limbs from 884 patients with CLI due to isolated infrapopliteal lesions who underwent EVT with angioplasty alone were enrolled. Outcome measures were freedom of major adverse limb event with perioperative death (MALE+POD) and amputation-free survival (AFS). Cox proportional hazards models were used to assess independent predictors for outcomes.
Results: Freedom from MALE+POD was 82±1% and 74±2% at 1 and 5 years, respectively. Risk factors associated with MALE+POD were age≥80 years (adjusted hazard ratio, 0.4; P<0.001), non-ambulatory status (2.0; P<0.001), Albumin<3.0g/dl (1.4; P<0.0001), Rutherford 6 (2.2; P<0.001), CRP≥3.0mg/dl (2.1; P<0.001) and below-the-ankle disease (2.0; P<0.001). On the other hand, 1- and 5-year AFS was 71±2% and 38±3%, respectively. Risk factors associated with major amputation/mortality were non-ambulatory status (adjusted hazard ratio 2.1; P<0.001), BMI<18.5 kg/m2 (1.4; P=0.02), Albumin<3.0g/dl (1.8; P<0.0001), end stage renal disease (1.4; P=0.004), ejection fraction<50% (1.6; P<0.001), Rutherford 6 (1.9; P<0.001), CRP≥3.0mg/dl (1.7; P<0.0001) and below-the-ankle disease (1.8; P<0.001). In patients with more than 4 risk factors, both endpoints at 1 year were below the 71% suggested as efficacy objective performance goal.
Conclusion: Long-term clinical outcomes were acceptable after EVT for patients with CLI due to isolated infrapopliteal lesion. Risk stratification by baseline characteristics is useful in estimating their long-term prognosis.
- © 2012 by American Heart Association, Inc.