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. 2022 Jun;52(6):429-440.
doi: 10.4070/kcj.2021.0342. Epub 2022 Feb 10.

Long-term Clinical Outcomes and Prognostic Factors After Endovascular Treatment in Patients With Chronic Limb Threatening Ischemia

Jung-Joon Cha #  1 , Jong-Youn Kim #  2 , Hyoeun Kim  3 , Young-Guk Ko  4 , Donghoon Choi  4 , Jae-Hwan Lee  5 , Chang-Hwan Yoon  6 , In-Ho Chae  6 , Cheol Woong Yu  1 , Seung Whan Lee  7 , Sang-Rok Lee  8 , Seung Hyuk Choi  9 , Yoon Seok Koh  10 , Pil-Ki Min  11 ; K-VIS (Korean Vascular Intervention Society) investigators
Affiliations

Long-term Clinical Outcomes and Prognostic Factors After Endovascular Treatment in Patients With Chronic Limb Threatening Ischemia

Jung-Joon Cha et al. Korean Circ J. 2022 Jun.

Abstract

Background and objectives: Endovascular therapy (EVT) first strategy has been widely adopted for the treatment of chronic limb threatening ischemia (CLTI) patients in real-world practice. This study aimed to investigate long-term outcomes of CLTI patients who underwent EVT and identify prognostic factors.

Methods: From the retrospective cohorts of a Korean multicenter endovascular therapy registry, 1,036 patients with CLTI (792 men, 68.8 ± 9.5 years) were included. The primary endpoint was amputation-free survival (AFS) defined as the absence of major amputation or death. Secondary endpoints were major adverse limb events (MALE; a composite of major amputation, minor amputation, and reintervention).

Results: Five-year AFS and freedom from MALE were 69.8% and 61%, respectively. After multivariate analysis, age (hazard ratio [HR], 1.476; p<0.001), end-stage renal disease (ESRD; HR, 2.340; p<0.001), Rutherford category (RC) 6 (HR, 1.456; p=0.036), and suboptimal EVT (HR, 1.798; p=0.005) were identified as predictors of major amputation or death, whereas smoking (HR, 0.594; p=0.007) was protective. Low body mass index (HR, 1.505; p=0.046), ESRD (HR, 1.648; p=0.001), femoropopliteal lesion (HR, 1.877; p=0.004), RC-6 (HR, 1.471; p=0.008), and suboptimal EVT (HR, 1.847; p=0.001) were predictors of MALE. The highest hazard rates were observed during the first 6 months for both major amputation or death and MALE. After that, the hazard rate decreased and rose again after 3-4 years.

Conclusions: In CLTI patients, long-term outcomes of EVT were acceptable. ESRD, RC-6, and suboptimal EVT were common predictors for poor clinical outcomes.

Trial registration: ClinicalTrials.gov Identifier: NCT02748226.

Keywords: Endovascular procedures; Peripheral arterial disease; Prognosis; Treatment outcome.

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Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Figure 1
Figure 1. Kaplan–Meier survival curve and hazard rate of major amputation or death after endovascular treatment. (A) Kaplan-Meier survival curve demonstrating amputation-free survival after endovascular treatment in 1,036 patients with chronic limb threatening ischemia. (B) Hazard rate for major amputation or death after endovascular treatment at 6-month interval.
CI = confidence interval.
Figure 2
Figure 2. Kaplan–Meier survival curve and hazard rate of MALE after endovascular treatment. (A) Kaplan-Meier survival curve demonstrating freedom from MALE in 1,036 patients with chronic limb threatening ischemia. (B) Hazard rate for MALE after endovascular therapy at 6-month interval.
CI = confidence interval; MALE = major adverse limb events.
See this image and copyright information in PMC

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