SS2. Congestive Heart Failure with Systolic Dysfunction Is Associated with Decreased Patency after Endovascular Intervention for Symptomatic Peripheral Arterial Disease

Abstract

Congestive heart failure (CHF) predicts morbidity and mortality after treatment of peripheral arterial disease. The impact on procedural success, however, remains unknown. We hypothesized that CHF with reduced left ventricular ejection fraction (LVEF) results in a diminished perfusion pressure and a low-flow state that could predispose arterial interventions to fail. A prospective database identified patients with CHF who underwent endovascular arterial intervention from 2004-2009. Demographics, co-morbidities, intervention, LVEF, and outcomes were recorded. Patients were followed clinically and by duplex ultrasound. Kaplan-Meier survival analysis and Cox Regression were used. Of 1220 patients undergoing intervention, 271 patients (22%) with documented CHF underwent intervention for claudication (23%) or critical limb ischemia (CLI) (77%). Primary patency at 1 year was 51.9±2.5% among those with CHF, compared to 64.6±1.3% in controls (p<0.001). In the setting of CHF, 1 year patency was 56.6±4.1% if LVEF>40% vs 43.2±3.5% if LVEF<40% (p<0.001). (Table 1). Among those with CLI, limb salvage rates were equivalent between controls and patients with CHF and LVEF>40%, but worse with LVEF<40% (p=0.01) and LVEF<20% (p<0.001).Table 1Primary PatencyPatency at 12 monthsPatency at 24 monthsPatency at 36 monthsControl64.6 ± 1.353.1 ± 1.447.5 ± 1.6CHF51.9 ± 2.542.8 ± 2.738.5 ± 2.8LVEF>40%56.6 ± 4.145.9 ± 4.436.0 ± 4.8LVEF<40%43.2 ± 3.526.9 ± 3.716.8 ± 4.9P-ValuesControl vs CHF<.001⁎Statistically Significant.<.001⁎Statistically Significant.<.001⁎Statistically Significant.Control vs CHF (LVEF<40%)<.001⁎Statistically Significant.<.001⁎Statistically Significant.<.001⁎Statistically Significant.Control vs CHF (LVEF>40%)0.03⁎Statistically Significant.0.0510.057LVEF>40% vs LVEF<40%0.008⁎Statistically Significant.<.001⁎Statistically Significant.<.001⁎Statistically Significant. Statistically Significant. Open table in a new tab CHF is an independent risk factor for failure of endovascular intervention. Specifically, low LVEF (<40%) predicts loss of patency. The inverse association between patency and LVEF needs further assessment.