Reinterventions after Endovascular Revascularization in Elderly Patients with Critical Limb Ischemia: An Observational Study

Abstract

Endovascular-first strategy for critical limb ischemia is widely accepted, especially in elderly patients, because of the increasing patency rates and minimally invasive character. Nonetheless, the impact of reinterventions because of endovascular treatment failure in this population is not well known. The aim of this study was to evaluate the reintervention rate and outcomes following reinterventions. Patients aged >70years with critical limb ischemia as a result of aortoiliac, femoropopliteal, and/or crural disease, treated by "endovascular-first strategy" between 2006 and 2013, were retrospectively analyzed. Follow-up was until 31 December 2014. Primary end point was freedom from reintervention or major amputation. Secondary outcome measures were limb salvage and mortality after reintervention. Reintervention was defined as endovascular or surgical re-revascularization and categorized into early reintervention (<3months) and late reintervention (>3months). In total, 263 patients were treated by endovascular revascularization. The majority (60%) of the treated lesion was located in the femoropopliteal segment. In total, a reintervention was performed in 32%, with 48% performed within 3 months. Freedom from reintervention or major amputation at 1 and 3years was 0.71±0.03 and 0.61±0.03, respectively. The 1-year Kaplan-Meier estimate amputation-free survival was 0.35±0.06 in the early reintervention group, compared with 0.73±0.06 in the late reintervention group and 0.71±0.04 in the no reintervention group (P<0.001; log rank). The 1-year mortality in the early reintervention group was 0.35±0.06, compared with 0.14±0.05 in the late reintervention group and 0.29±0.04 in the group who did not require reintervention (P=0.047; log rank). Endovascular revascularization first strategy for critical limb ischemia results in high reintervention rates in elderly patients. Failure of the endovascular revascularization requiring early reintervention is associated with lower amputation-free survival.