Abstract
Introduction: Although contemporary femoropopliteal (FP)-specific stents have shown durable patency in endovascular therapy (EVT), acute limb ischemia (ALI) caused by stent thrombosis (ST) are substantially experienced in clinical setting. The current study investigated that impact of ALI caused by FP-ST on clinical outcomes in patients with lower extremity artery disease (LEAD). Methods: The current study was multicenter and retrospective study enrolling 498 ALI patients (mean age: 76 years, male: 59%, diabetes mellitus [DM]: 34%, hemodialysis [HD]: 19%). We compared clinical outcomes of 105 ALI caused by FP-ST (ST-ALI) with 347 ALI caused by de novo thrombosis or embolus (de novo-ALI) presenting Rutherford category I or II. Outcome measure was 12-month amputation free survival (AFS), and predictors of AFS were also investigated using multivariate Cox proportional hazard analysis. Results: Frequency of DM (63% vs. 26%) and HD (51% vs. 10%) was higher in ST-ALI, while average age was older (74 years vs. 77 years) and frequency of atrial fibrillation (Af) (18% vs. 49%) was higher in de novo-ALI. In patients presenting with Rutherford category I or II ALI, The 12-month AFS was significantly lower in ST-ALI than in de novo-ALI (52.2±5.1% vs. 75.6±2.5%, p<0.001). Multivariate analysis revealed that ST-ALI (hazard ratio [HR]: 1.77, 95% confidential interval [CI] 1.18-2.65, p=0.006) as well as age (HR: 1.03, 95%CI 1.01-1.05, p=0.008), HD (HR: 2.58, 95%CI 1.64-4.04, p<0.001), Af (HR: 1.77, 95%CI 1.18-2.65, p=0.006), presence of wound (HR: 1.78, 95%CI 1.10-2.88, p=0.018), peak CRP value (HR: 1.05, 95%CI 1.03-1.07, p<0.001) and non-ambulatory status (HR: 2.17, 95%CI 1.41-3.31, p<0.001) were significantly associated with low 12-month AFS. Conclusions: In patients presenting with Rutherford category I or II ALI, ST-ALI, age, hemodialysis, presence of wound, atrial fibrillation, peak CRP value and non-ambulatory status adversely impact on 12-month AFS.
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