Clinical Results of Single Versus Multiple-Vessel Infrapopliteal Intervention

Abstract

The effects of concomitant endovascular interventions on multiple infrapopliteal vessels are not well known, and the long-term sequelae of such procedures have not been reported. From 2004 to 2014, 673 patients underwent an infrapopliteal endovascular intervention for tissue loss (77%), rest pain (13%), stenosis of a previously treated vessel (5%), acute limb ischemia (3%), or claudication (2%). Data collected included renal artery stenosis (RAS) events (revascularization, major amputation, or stenosis [>3.5× step-up by duplex]) and wound healing. Patients without an initial indication of critical limb ischemia (CLI) were excluded. Patients were characterized by single-vessel infrapopliteal interventions and multiple-vessel infrapopliteal interventions. Worsened Rutherford class between index procedure and failure was also noted. Of the 673 patients, 596 underwent an infrapopliteal endovascular intervention for CLI: 85% for tissue loss and 15% for rest pain. During a single procedure, 533 (89%) patients underwent a single-vessel intervention, and 63 (11%) underwent a multiple-vessel intervention. Patients undergoing a single-vessel intervention had more commonly experienced a prior ipsilateral endovascular procedure (17% vs 10%; P = .04), whereas patients undergoing a multiple-vessel intervention more often suffered from diabetes (78% vs 89%; P = .03) and were more often discharged to a rehabilitation facility (33% vs 41%; P = .04). Survival analysis revealed no difference in the proportion of patients experiencing a restenosis (P = .11). A Cox regression model illustrated that long-term outcomes do not differ between patients undergoing a multiple-vessel intervention vs those undergoing a single-vessel intervention. Among the 596 patients, a RAS event occurred in 284 limbs (48%), and there was no significant difference in the rate of RAS events between single-vessel and multiple-vessel infrapopliteal interventions (48% vs 49%; P = .84; Fig). The amputation rate also did not significantly differ between the two groups (14% vs 16%; P = .71). In both groups, 8% of RAS patients presented with a worse ischemia class compared with their initial symptoms. Our data suggest that multiple-vessel intervention does not improve outcomes compared with single-vessel intervention after any infrapopliteal procedure for CLI.