O-137 - SAFETY AND EFFICACY OF ENDOVASCULAR INFRAPOPLITEAL REINTERVENTIONS IN PATIENTS WITH CHRONIC LIMB-THREATENING ISCHEMIA

TOPIC:
Peripheral Occlusive Arterial Disease
AUTHORS:
Kleiss S. (UMCG ~ Groningen ~ Netherlands) , Van Mierlo-Van Den Broek P. (Maasstad Hospital Rotterdam ~ Rotterdam ~ Netherlands) , Vos C. (Martini Hospital Groningen ~ Groningen ~ Netherlands) , Fioole B. (Maasstad Hospital Rotterdam ~ Rotterdam ~ Netherlands) , Bloemsma G. (Medical Imaging Center, UMCG ~ Groningen ~ Netherlands) , De Vries-Werson D. (UMCG ~ Groningen ~ Netherlands) , Bokkers R. (Medical Imaging Center, UMCG ~ Groningen ~ Netherlands) , De Vries J. (UMCG ~ Groningen ~ Netherlands)
Introduction:
Endovascular revascularization is the preferred treatment to improve perfusion of the lower extremity in patients with chronic limb-threatening ischemia (CLTI). Patients with CLTI often present with stenotic-occlusive lesions involving the infrapopliteal arteries. The frequency of treating infrapopliteal lesions is increasing; however, reintervention rates are high. This study aimed to determine the safety and efficacy of infrapopliteal endovascular reinterventions.
Methods:
This retrospective, multicenter cohort study included patients who underwent an endovascular infrapopliteal reintervention after primary infrapopliteal intervention for CLTI. Technical success rate was recorded. The clinical outcome measures for safety of the reintervention procedures were the mortality rate and complication rate at 30 days. The clinical outcome measures for efficacy of the reinterventions were overall survival, amputation-free survival (AFS), freedom from major amputation, major adverse limb event (MALE), and repeated reinterventions. Cox proportional hazard models were used to determine risk factors for AFS and freedom from major amputation or repeated reintervention.
Results:
Included were 81 CLTI patients, and 87 limbs received an endovascular infrapopliteal reintervention. In the 87 limbs, 122 lesions were treated, with a technical success achieved in 99 lesions (81%). The 30-day mortality rate was 1%, and the complication rate was 13%. Overall survival and AFS at 1 year were 69% (95% confidence interval [CI], 55%-79%) and 45% (95% CI 33%-56%), respectively, and at 2.5 years were 54% (95% CI, 37%-67%) and 21% (95% CI, 11%-33%), respectively. KM curves for patient survival and AFS are shown in Figure 1. Freedom from major amputation, MALE, and repeated reinterventions at 1 year were 59% (95% CI, 46%-70%), 54% (95% CI, 41%-65%), and 68% (95% CI, 55%-78%), respectively, and at 2.5 years were 41% (95% CI, 25%-56%), 36% (95% CI, 21%-51%), and 51% (95% CI, 33%-66%), respectively. A high GLASS score of III showed an increased hazard ratio of 6.896 (95% CI, 1.947-24.429; p=0.003) for freedom of major amputation or repeated reintervention. The multivariable hazard ratios for the analyzed risk factors for AFS and freedom of major amputation or repeated reintervention are shown in Table 1.
Conclusion:
The results of this multicenter retrospective study indicate that endovascular infrapopliteal reinterventions can be performed safely with low 30-day mortality and complication rates. However, the efficacy at 2.5 years follow-up was moderate to poor, with low AFS and high rates of major amputations and repeated reinterventions. Moreover, a high GLASS score of III was associated with a reduced freedom from major amputation or repeated reintervention. While the frequency of performing infrapopliteal reinterventions is increasing with additional growing complexity of the disease, alternative treatment options such as venous bypass grafting or deep venous arterialization may be considered and should be studied in randomized controlled trials.
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