Abstract 17625: Comparative Analysis of Mortality and Amputation Rates in Patients Undergoing Atherectomy for Infra-Popliteal Peripheral Arterial Disease: Insight From the VQI

Abstract

Introduction: Infra-popliteal peripheral arterial disease (IPPAD) poses challenges due to complex vasculature. The BASIL-2 trial demonstrated superiority in endovascular treatment compared with surgical bypass in patients with IPPAD. However, the choice of endovascular modality has not been conclusive. Hypothesis: Combining plain balloon angioplasty (POBA)+atherectomy is associated with improved clinical outcomes compared to POBA. Methods: Patients that underwent POBA vs POBA+Atherectomy for IPPAD from the Vascular Quality Initiative database were identified. Propensity score matching (PSM) was employed to balance the distribution of confounding variables for mortality identified on multivariable logistic regression. Patient characteristics and long-term outcomes between the two treatment groups were compared. Results: A total of 10,494 individuals (74.6%) were treated with POBA, while 3,569 (25.4%) were treated with POBA+atherectomy. PSM ensured minimal differences in baseline characteristics, such as indication for procedure and prior revascularization. The atherectomy group was associated with higher technical success and lower perioperative complications, such as renal complications and hematoma, at the expense of higher rates of distal embolization. During long term follow up, patients who underwent atherectomy had lower rates of major amputation but lower freedom from reintervention. There were no differences in major adverse limb events and mortality. Conclusion: Combining POBA with atherectomy appears to be a safe approach in IPPAD, with lower rates of long-term amputation at the cost of higher risk for future re-intervention.