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PVSS13. Improved Outcomes Result from Multilevel Endovascular Intervention Involving the Tibial Vessels Compared to Isolated Tibial Intervention

Mikel Sadek, Sharif H. Ellozy, Hyun J. Shin, Irene Turnbull, Honesto Poblete, Jonathan Bowman, Tikva Jacobs, Alfio Carroccio, Victoria J. Teodorescu, Robert Lookstein,  Michael L. Marin, Peter L. Faries.
Mount Sinai School of Medicine, New York, N.Y.

OBJECTIVES: There is increasing acceptance of percutaneous intervention as an alternative to surgery for disease of the tibial vessels. Tibial vessel disease can occur in conjunction with proximal level disease or in isolation. This study sought to determine whether requirement for multilevel intervention affected outcome.

METHODS: Consecutive patients undergoing infrapopliteal interventions from 11/2002 to present were evaluated for primary patency, secondary patency and limb salvage. Reintervention anywhere along the infrainguinal vessels was used in the evaluation of patency. Results were determined using Kaplan-Meier analysis.

RESULTS: The study included 87 patients, 91 limbs and 116 procedures [age 70.3±12.7 years, males 66.7%, and follow-up 245.8±290.8 days]. Procedural outcomes were: primary patency [6 months (68.3±6.2%), 12 months (49.9±8.0%), 18 months (36.6±8.9%)] and secondary patency [6 months (80.9±5.0%), 12 months (71.3±6.9%), 18 months (62.9±8.3%)]. Limb salvage rates in patients with CLI were: 6 months (84.5±0.1%), 12 months (81.2±0.1%), 18 months (68.7±0.1%). Factors associated with reduced patency were critical limb ischemia, creatinine>1.2 and diabetes. Multilevel compared to single-level intervention was associated with significantly improved secondary patency (p=0.045) [Figure 1]. End-stage renal disease, angina and chronic obstructive pulmonary disease were more prevalent in patients who underwent multilevel interventions. Otherwise, no significant demographic differences correlated with multilevel vs. single-level disease, including %CLI vs. claudication. Perioperative complications occurred infrequently: hematoma 4.3%, pseudoaneurysm 1.7%, myocardial infarction 1.1% and mortality 1.1%.

CONCLUSIONS: Patients who undergo multilevel intervention involving the tibial vessels have improved patency compared to those who undergo intervention for lesions isolated to the tibial vessels. This may reflect increased disease burden for those patients who undergo isolated tibial intervention.

Figure 1.