Number of infrapopliteal arteries undergoing endovascular treatment is not associated with the limb salvage rate in patients with critical limb ischemia

Abstract

The objective of this study was to determine whether the number of infrapopliteal arteries undergoing endovascular treatment is associated with the limb salvage rate in patients with critical limb ischemia (CLI). This was a retrospective, consecutive cohort study of CLI patients who underwent infrapopliteal angioplasty at the Vascular and Endovascular Surgery Service of the Hospital do Servidor Público Estadual, São Paulo, between January 2009 and January 2013. The primary outcome variable was the limb salvage rate. The secondary outcome variables were patency, survival, plantar arch quality, and operative mortality rate. Overall, 109 infrapopliteal angioplasties were performed in 92 patients, and the initial technical success rate was 95.6%. Based on the analyses of the arteriography of the endovascular procedures, the patients were classified into two groups according to whether they had undergone endovascular treatment of one artery (group 1) or two arteries (group2). The mean outpatient follow-up time was 430± 377.5days. The analyses were performed at 180 and 360days. There were 72 angioplasties (66%) in group 1 and 37 (34%) in group 2. Hypertension was more frequent in group 1 (93.1%) than in group 2 (78.4%; P= .03). Other clinical characteristics were similar in both groups. Regarding postoperative complications, the incidence of acute kidney failure was lower in group 1 (0% vs 8.1%, respectively; P= .037). The limb salvage rate at 360days was similar in groups 1 and 2 (89.4% vs 89.3%, respectively; P= .595). The secondary patency rate at 360days was also similar in groups 1 and 2 (59.9% vs 60.9%, respectively; P= .571). The perioperative mortality rate was lower in group 1 (4.2% vs 16.2%, respectively; P= .039), but the survival rate at 360days was similarin both groups (82.1% vs 75.1%, respectively; P= .931). The frequencies of complete, incomplete, and absent plantar arch were similar in both groups. The estimated limb salvage rates for patients with complete plantar arch or incomplete/absent plantar arch were 96.2% and 84.6%, respectively (P= .467), at 360days. Our results suggest that it is not necessary to treat the largest number of arteries possible in CLI patients. Instead, the most amenable artery for endovascular procedures should be treated to improve limb salvage and secondary patency rates.