Clinical Effect of Revascularization Strategies and Pharmacologic Treatment on Long-Term Results in Patients with Advanced Peripheral Artery Disease with TASC C and D Femoropopliteal Lesions.

Chiu-Yang Lee,Piotr Musialek

doi:10.1155/2022/3741967

Abstract

Background This study was to assess the clinical outcome and associated parameters of endovascular therapy (EVT group) and bypass surgery (bypass group) in patients with long femoropopliteal TransAtlantic Inter-Society Consensus II (TASC II) C and D peripheral artery disease (PAD). Methods 187 patients who underwent successful EVT or bypass surgery were assessed. The endpoints included the events of cardiovascular disease (CVD) and lower-extremity amputation (LEA), 3-year primary patency, and 3-year amputation-free survival (AFS). Results The 3-year primary and secondary patency rates were better in the bypass group (P=0.007 and P=0.039, respectively), while the incidences of LEA, new CVD events, and mortality were comparable between groups. Weighted multivariate Cox analyses showed that cilostazol treatment (hazard ratio (HR): 0.46, 95% confidence interval (CI): 0.3–0.72, P=0.001), statin treatment (HR: 0.54, 95% CI: 0.33–0.9, P=0.014), and direct revascularization (DR) (HR: 0.47, 95% CI: 0.29–0.74, P=0.001) were predictive factors of 3-year primary patency. Kaplan–Meier curve analyses of time-to-primary cumulative AFS showed that nondiabetes mellitus, mild PAD, and cilostazol and statin treatment were correlated with a superior 3-year AFS (log rank test, P=0.001, P < 0.001, P=0.009, and P=0.044, respectively). Conclusions Endovascular stenting based on the angiosome concept and bypass surgery provide comparable benefits for the treatment of long, advanced femoropopliteal lesions after a short follow-up period, whereas cilostazol therapy for more than 3 months, aggressive treatment of dyslipidemia, and surgical revascularization were associated with higher primary patency.

Highlights

Peripheral arterial disease (PAD) is a prevalent type of atherosclerosis and is similar to coronary artery disease (CAD), which is caused by atherosclerosis.Critical limb ischemia (CLI) is associated with high cardiovascular disease mortality and lower-extremity amputation (LEA) [1, 2]; it is the most severe form of PAD, presenting as gangrene, pain at rest, and ischemic ulcer necrosis. e TransAtlantic Inter-Society Consensus (TASC) II guidelines recommend revascularization approaches including endovascular intervention and bypass surgery for CLI
All patients had advanced PAD manifested as severe claudication (9.1%), resting ischemic pain (25.7%), or tissue loss (74.3%) (Rutherford category ≥ V)
All diseased arteries were characterized using pretreatment imaging results based on the stratification of lesions as per the updated 2015 TransAtlantic Inter-Society Consensus II (TASC II) classification for aortoiliac, femoropopliteal, and infrapopliteal lesions [3]

Summary

Introduction

Peripheral arterial disease (PAD) is a prevalent type of atherosclerosis and is similar to coronary artery disease (CAD), which is caused by atherosclerosis.Critical limb ischemia (CLI) is associated with high cardiovascular disease mortality and lower-extremity amputation (LEA) [1, 2]; it is the most severe form of PAD, presenting as gangrene, pain at rest, and ischemic ulcer necrosis. e TransAtlantic Inter-Society Consensus (TASC) II guidelines recommend revascularization approaches including endovascular intervention and bypass surgery for CLI. E TASC II guidelines recommend endovascular intervention as the optimal option for the treatment of CLI to relieve pain, assist wound healing, prevent limb loss, and improve patient function and quality of life. Taking long-term durability into consideration, bypass surgery remains the optimal treatment for multilevel and Journal of Interventional Cardiology long femoropopliteal lesions not subject to endovascular intervention and provides adequate arterial perfusion to the foot, resulting in an elevated limb salvage rate and long-term durability [6, 7]. Taking the results of all of the aforementioned reviews together, the unique emphasis on surgical or endovascular revascularization strategies as the basis of current treatment for long femoropopliteal lesions in patients with PAD was not sufficient without comprehensive strategies for reduction of restenosis and arterial remolding

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Conclusion