Outcome of Claudication Patients Treated With Endovascular Intervention

Abstract

Previous reports have suggested that peripheral vascular intervention (PVI) for intermittent claudication (IC) may be associated with poor outcome, progression to chronic limb-threatening ischemia (CLTI), and a higher risk of amputation. These data often arise from large database studies, which lack granularity and combine patients treated in various settings by a variety of providers. The aim of this study is to define the outcomes of claudication patients treated with PVI and specifically understand the risk of deterioration to CLTI and/or amputation. We performed a review of patients undergoing PVI for IC between 2011 and 2019 at single institution. Patients who underwent isolated aortoiliac intervention or hybrid procedures were excluded. Primary patency (PP), target vessel revascularization, limb salvage, and overall survival were analyzed using the Kaplan-Meier method and assessed with univariate analysis and multivariable Cox regression. Loss of PP (restenosis) was defined as a peak systolic velocity ratio of more than 2.0 on duplex ultrasound examination, a decrease in the ankle-brachial index of more than 0.15 or more than 20%, or imaging with a computed tomography scan or catheter-based angiography. We identified 393 patients with a mean age of 68.6 years (63% male) with multiple risk factors for atherosclerosis (Table). Mean follow-up was 44.1 ± 24.5 months. PP was 82.0% at 36 months and 74.3% at 60 months (Figure). Freedom from target vessel revascularization was 71.8%, overall survival was 71.1%, and limb salvage was 97.2% at 60 months. Univariate and multivariate analyses found that dialysis dependence was associated with restenosis. Paclitaxel use enhanced PP on univariate analysis while atherectomy did not have a detrimental effect. Multivariate analysis also demonstrated that male sex was associated with PP. Of the 67 patients who had restenosis, 23 were asymptomatic and were managed medically. Forty-four patients underwent revision—34 endovascular and 10 surgical. At 60 months, a total of 10 patients underwent amputation (2.8% by Kaplan-Meier estimate). Patients with IC can be treated with PVI with high rates of technical success and patency. Patients on dialysis fare worse. Progression to CLTI and amputation is low. Whether PVI for IC is preferential to medical therapy alone requires further study.TableVariableAll (n = 393)PP (n = 326)Restenosis (n = 67)P valueMultivariate analysis for restenosis (hazard ratio)P valueAge68.6 ± 10.769.0 ± 10.666.8 ± 9.9.1310.98.266Male sex251 (63.9)211 (64.7)40 (59.7).4360.53.039Hypertension348 (88.6)286 (87.7)62 (92.5).2601.52.413Hyperlipidemia294 (74.8)243 (76.1)51 (74.4).7861.05.879Coronary artery disease215 (54.7)177 (54.3)38 (56.7).7171.57.158Diabetes mellitus184 (46.8)153 (46.9)31 (46.3).9210.77.391Chronic pulmonary obstructive disease89 (22.7)70 (21.5)19 (28.4).2201.80.085Congestive heart failure63 (16.0)55 (16.9)8 (11.9).3160.57.226Carotid artery disease95 (24.2)177 (54.3)38 (56.7).7170.56.121Abdominal aortic aneurysm25 (6.4)21 (6.4)4 (6.0).8850.54.333Dialysis13 (3.3)6 (1.8)7 (10.45)<.0018.30.001History of smoking334 (85.0)279 (85.6)55 (82.1).4660.79.572Atherectomy103 (26.2)90 (27.6)13 (19.4).1640.93.845Uncoated balloon angioplasty156 (39.7)121 (37.1)35 (52.2).0210.76.802Paclitaxel balloon angioplasty235 (59.8)204 (62.6)31 (46.3).0130.56.593Bare metal stent123 (31.3)97 (29.75)26 (38.8).1461.56.132PP, Primary patency. Open table in a new tab