Outcomes of Lower Extremity Endovascular Revascularization: Potential Predictors and Prevention Strategies

Abstract

Peripheral artery disease (PAD) is a manifestation of atherosclerosis, which may affect arteries of the lower extremities. The most dangerous PAD complication is chronic limb-threatening ischemia (CLTI). Without revascularization, CLTI often causes limb loss. However, neither open surgical revascularization nor endovascular treatment (EVT) ensure long-term success and freedom from restenosis and revascularization failure. In recent years, EVT has gained growing acceptance among all vascular specialties, becoming the primary approach of revascularization in patients with CLTI. In clinical practice, different clinical outcomes after EVT in patients with similar comorbidities undergoing the same procedure (in terms of revascularization technique and localization of the disease) cause unsolved issues that need to be addressed. Nowadays, risk management of revascularization failure is one of the major challenges in the vascular field. The aim of this literature review is to identify potential predictors for lower extremity endovascular revascularization outcomes and possible prevention strategies.

Keywords: chronic limb-threatening ischemia (CLTI); peripheral artery disease (PAD); revascularization.

Figure 1

Essential principles to prevent failure of Lower extremity endovascular revascularization (LER). PLAN: Patient risk estimation, Limb severity, ANatomic disease patter; BP: blood pressure; HbA1c: glycated hemoglobin; FBG: fasting blood glucose; eGFR: estimated glomerular filtration rate; CRP: C-reactive protein; TNF-α: tumor necrosis factor-α; ABI: ankle brachial index; DUS: duplex ultra sound; DAPT: dual antiplatelet therapy.