Distal Embolization During Lower Extremity Endovascular Interventions

Abstract

Distal embolization (DE) during peripheral arterial endovascular interventions is a well-known complication that is poorly studied. The goal of this project was to determine the incidence, risk factors, and effect of DE on the outcomes of lower extremity endovascular interventions (LEI). All LEI between 2010 and 2014 in the Vascular Study Group of New England database were reviewed. Patient characteristics were analyzed to determine predictors of DE. LEI involving the superficial femoral artery (SFA) were reviewed to assess the effect of type of treatment on DE. The outcomes examined were loss of patency, limb loss, and mortality after LEI involving the SFA. A multivariable regression was used to determine predictors of DE. SAS and STAT 9.4 software were used for all analyses. There were a total of 10,856 procedures. The incidence of DE was 17.3/1000 procedures, and 68% required treatment (57% endovascular, 11% open surgery). DE was more common in patients with diabetes (relative risk [RR], 1.51; 95% confidence interval [CI], 1.11-2.04), and in urgent (RR, 1.91; 95% CI, 1.37-2.66) and emergency (RR, 3.43; 95% CI, 1.77-6.67) procedures compared with elective procedures. The use of aspirin/P2Y12 antagonists and statins were associated with lower incidence of DE (RR, 0.65; 95% CI, 0.46-0.92; RR, 0.66; 95% CI, 0.49-0.90, respectively). DE increased with the number of arteries treated (P < .0001), and with the length of occlusion (P < .0001). The SFA was the most commonly treated artery (4751 [43.7%]). The combined treatment modalities of balloon angioplasty and atherectomy as well as stenting and atherectomy had higher risk of DE compared with balloon angioplasty and stenting of the SFA (RR, 3.20; 95% CI, 1.91-5.37; RR, 3.15; 95% CI, 1.62-6.12, respectively). DE was not significantly associated with loss of patency, major amputation, or mortality. The incidence of DE during LEI is 1% to 2% and increases with atherectomy. The use of platelet inhibitors and statins seems to be protective.