3:18 PM Abstract No. 310 Outcomes of infrapopliteal stenting for critical limb ischemia

Abstract

To evaluate outcomes of infrapopliteal artery stenting including target lesion revascularization (TLR), patency, and subsequent major adverse limb events (MALE) in the setting of critical limb ischemia (CLI). A retrospective single-center review was performed of patients undergoing stenting for early restenosis or failed angioplasty within the tibioperoneal trunk, tibial or peroneal arteries for CLI between January 2010 and August 2019 (n = 49 limbs in 43 patients). Patients received at least one or more drug-eluting (n = 48) or bare-metal stents (n = 1). Freedom from TLR was the primary measure defined as any repeat percutaneous intervention of the target lesion. Other measures included primary and secondary patency, defined with ultrasound Doppler showing peak systolic velocity ratio >2.0 or confirmed angiographically. Limb salvage was defined as freedom from major amputation at or above the ankle. Freedom from MALE was composite freedom from TLR, primary patency, and major amputation. Patient demographics were mean age 70 ± 12 years (SD) with 67% men, 90% hypertension, 56% dyslipidemia, 54% diabetes, 27% ESRD, 45% smoking history and 100% CLI. Mean follow-up time was 10.3 months (range, 0-52); 9 patients underwent TLR (18% limbs). Kaplan-Meier analysis at 12-months for freedom from TLR, primary patency, and freedom from MALE (±SE) were 80 ± 7.1%, 67 ± 10.3%, and 60 ± 8.7%, respectively. Overall limb salvage rate was 71% (35/49) with 2 of the major amputations occurring beyond 12 months from index procedure. No major procedural complications occurred. One stent fracture with occlusion was observed. 1 patient had a non-fatal myocardial infarction and 1 patient had a stroke; 7 other patients died during follow-up, with 2 PAD-related deaths at 1 and 12 months. Other deaths were from cardiac, pulmonary embolus, pancreatic cancer, pneumonia, and one unknown cause 4-33 months post stenting. Stenting in the infrapopliteal arteries had high rates of freedom from target vessel revascularization and limb salvage. Further studies involving long-term outcomes and safety profiles are needed for currently used stents within the infrapopliteal vasculature.