Ruby C. Lo, Rodney P. Bensley, Kristina A. Giles, Jeremy D. Darling, Mark Wyers, Allen D. Hamdan, Elliot Chaikof, Marc L. Schermerhorn
Beth Israel Deaconess Medical Center, Boston, MA.
OBJECTIVES: Infrapopliteal angioplasty (PTA) is routinely used to treat critical limb ischemia (CLI) despite limited data on long-term outcomes.
METHODS: We reviewed all patients undergoing infrapopliteal PTA for CLI from 2004 to 2011 stratified by TASC class. Outcomes included restenosis, primary patency, reintervention (w/ PTA or bypass), amputation, complications, and survival.
RESULTS: Infrapopliteal PTA (stenting 14%, multilevel intervention 50%) was performed in 447 limbs of 401 patients (59% male) with technical success of 95% and perioperative complications in 11%. TASC composition was 17% A, 22% B, 29% C, and 35% D. All technical failures involved TASC D lesions. Mean follow-up was 15 months. Five-year survival was 46%. One- and 5-year primary patency was 55% & 36% and limb salvage was 84% & 81%. Restenosis was associated with TASC C (HR 2.1, 95%CI 1.1-3.8, p=.021) and TASC D (HR 2.1, 95% CI 1.0-4.0, p=.036) lesions. Amputation rates were higher in patients who were not candidates for bypass (HR 4.3, 95% CI 2.5-7.3, p<.001) and with TASC D lesions (HR 3.7, 95% CI 1.1-12.4, p=.032). Together, freedom from restenosis, revascularization or amputation was predicted by bypass non-candidacy (HR 1.6, 95% CI 1.1-2.4, p=.007) and TASC C (HR 1.8, 95% CI 1.1-3.0, p=.024) and TASC D (HR 2.0, 95% CI 1.2-3.3, p=.011) lesions but not multilevel intervention (HR .9, 95% CI 0.6-1.2, p=.462).
CONCLUSIONS: Infrapopliteal PTA is effective primary therapy for TASC A and B lesions. Multilevel intervention does adversely affect outcome.
AUTHOR DISCLOSURES: R. P. Bensley, Nothing to disclose; E. Chaikof, Nothing to disclose; J. D. Darling, Nothing to disclose; K. A. Giles, Nothing to disclose; A. D. Hamdan, Nothing to disclose; R. C. Lo, Nothing to disclose; M. L. Schermerhorn, Endologix, Consulting fees or other remuneration (payment), Medtronic, Consulting fees or other remuneration (payment), Boston Scientific, Consulting fees or other remuneration (payment); M. Wyers, Nothing to disclose.
Posted April 2012