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. 2022 Mar 4:2022:3741967.
doi: 10.1155/2022/3741967. eCollection 2022.

Clinical Effect of Revascularization Strategies and Pharmacologic Treatment on Long-Term Results in Patients with Advanced Peripheral Artery Disease with TASC C and D Femoropopliteal Lesions

Chiu-Yang Lee  1   2   3
Affiliations

Clinical Effect of Revascularization Strategies and Pharmacologic Treatment on Long-Term Results in Patients with Advanced Peripheral Artery Disease with TASC C and D Femoropopliteal Lesions

Chiu-Yang Lee. J Interv Cardiol. .

Abstract

Background: This study was to assess the clinical outcome and associated parameters of endovascular therapy (EVT group) and bypass surgery (bypass group) in patients with long femoropopliteal TransAtlantic Inter-Society Consensus II (TASC II) C and D peripheral artery disease (PAD).

Methods: 187 patients who underwent successful EVT or bypass surgery were assessed. The endpoints included the events of cardiovascular disease (CVD) and lower-extremity amputation (LEA), 3-year primary patency, and 3-year amputation-free survival (AFS).

Results: The 3-year primary and secondary patency rates were better in the bypass group (P=0.007 and P=0.039, respectively), while the incidences of LEA, new CVD events, and mortality were comparable between groups. Weighted multivariate Cox analyses showed that cilostazol treatment (hazard ratio (HR): 0.46, 95% confidence interval (CI): 0.3-0.72, P=0.001), statin treatment (HR: 0.54, 95% CI: 0.33-0.9, P=0.014), and direct revascularization (DR) (HR: 0.47, 95% CI: 0.29-0.74, P=0.001) were predictive factors of 3-year primary patency. Kaplan-Meier curve analyses of time-to-primary cumulative AFS showed that nondiabetes mellitus, mild PAD, and cilostazol and statin treatment were correlated with a superior 3-year AFS (log rank test, P=0.001, P < 0.001, P=0.009, and P=0.044, respectively).

Conclusions: Endovascular stenting based on the angiosome concept and bypass surgery provide comparable benefits for the treatment of long, advanced femoropopliteal lesions after a short follow-up period, whereas cilostazol therapy for more than 3 months, aggressive treatment of dyslipidemia, and surgical revascularization were associated with higher primary patency.

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Conflict of interest statement

The author declares no conflicts of interest.

Figures

Figure 1
Figure 1
(a) Patients who underwent bypass surgery had a better patency rate than patients who received stenting treatment (log rank test, P=0.007). (b) Patients who received cilostazol treatment for more than 3 months had a patency rate than patients who received treatment for fewer than 3 months (log rank test, P < 0.001). (c) Patients receiving statin treatment had a patency rate than those who did not receive treatment (log rank test, P < 0.001).
Figure 2
Figure 2
(a) Patients who received cilostazol treatment for more than 3 months had a better 3-year amputation-free survival (AFS) rate than patients who received treatment for fewer than 3 months (log rank test, P=0.001). (b) Patients receiving statin treatment had a superior 3-year AFS rate to those who did not receive treatment (log rank test, P < 0.001). (c) Patients who presented with TASC D peripheral artery disease (PAD) had an inferior 3-year AFS rate than patients who had TASC B plus C PAD (log rank test, P=0.009). (d) Patients with diabetes mellitus had a poorer 3-year AFS rate than patients without DM (log rank test, P=0.044).
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