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

다국어 초록 (Multilingual 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.

참고문헌 (Reference)

1 Soga Y, "Two-year life expectancy in patients with critical limb ischemia" 7 : 1444-1449, 2014

2 Farber A, "The current state of critical limb ischemia : a systematic review" 151 : 1070-1077, 2016

3 Schmidt A, "Retrograde tibioperoneal access for complex infrainguinal occlusions : short-and long-term outcomes of 554 endovascular interventions" 12 : 1714-1726, 2019

4 Rutherford RB, "Recommended standards for reports dealing with lower extremity ischemia : revised version" 26 : 517-538, 1997

5 Mustapha JA, "Propensity score-adjusted comparison of long-term outcomes among revascularization strategies for critical limb ischemia" 12 : e008097-, 2019

6 O’Brien-Irr MS, "Outcomes after endovascular intervention for chronic critical limb ischemia" 53 : 1575-1581, 2011

7 Stella J, "Outcome of patients with chronic limb-threatening ischemia with and without revascularization" 49 : 121-127, 2020

8 Lin JH, "Endovascular-first treatment is associated with improved amputation-free survival in patients with critical limb ischemia" 12 : e005273-, 2019

9 Vierthaler L, "Determinants of survival and major amputation after peripheral endovascular intervention for critical limb ischemia" 62 : 655-664, 2015

10 Mustapha JA, "Determinants of Long-term outcomes and costs in the management of critical limb ischemia : a population-based cohort study" 7 : e009724-, 2018

11 Dalal PK, "Contemporary outcomes of endovascular intervention for critical limb ischemia" 6 : 251-259, 2017

12 Murata N, "Complex relationship of body mass index with mortality in patients with critical limb ischemia undergoing endovascular treatment" 49 : 297-305, 2015

13 Adam DJ, "Bypass versus angioplasty in severe ischaemia of the leg(BASIL) : multicentre, randomised controlled trial" 366 : 1925-1934, 2005

14 Bradbury AW, "Bypass versus Angioplasty in Severe Ischaemia of the Leg(BASIL)trial : an intention-to-treat analysis of amputation-free and overall survival in patients randomized to a bypass surgery-first or a balloon angioplasty-first revascularization strategy" 51 : 5-, 2010

15 고영국 ; 안철민 ; 민필기 ; 이재환 ; 윤창환 ; 유철웅 ; 이승환 ; 이상록 ; 최승혁 ; 고윤석 ; 채인호 ; 최동훈 ; K-VIS investigators, "Baseline Characteristics of a Retrospective Patient Cohort in the Korean Vascular Intervention Society Endovascular Therapy in Lower Limb Artery Diseases (K-VIS ELLA) Registry" 대한심장학회 47 (47): 469-476, 2017

16 Almasri J, "A systematic review and meta-analysis of revascularization outcomes of infrainguinal chronic limb-threatening ischemia" 68 : 624-633, 2018

17 Iida O, "3-Year outcomes of the OLIVE registry, a prospective multicenter study of patients with critical limb ischemia : a prospective, multi-center, three-year follow-up study on endovascular treatment for infra-inguinal vessel in patients with critical limb ischemia" 8 : 1493-1502, 2015

18 Aboyans V, "2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery(ESVS) : document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by : the European Stroke Organization(ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology(ESC)and of the European Society for Vascular Surgery(ESVS)" 39 : 763-816, 2018

19 Gerhard-Herman MD, "2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease : a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines" 135 : e726-79, 2017