PMID- 36609175
OWN - NLM
STAT- Publisher
LR  - 20240216
IS  - 1545-1550 (Electronic)
IS  - 1526-6028 (Linking)
DP  - 2023 Jan 7
TI  - Outcomes and Patency of Endovascular Infrapopliteal Reinterventions in Patients 
      With Chronic Limb-Threatening Ischemia.
PG  - 15266028221147457
LID - 10.1177/15266028221147457 [doi]
AB  - PURPOSE: Endovascular revascularization is the preferred treatment to improve 
      perfusion of the lower extremity in patients with chronic limb-threatening 
      ischemia (CLTI). Patients with CLTI often present with stenotic-occlusive lesions 
      involving the infrapopliteal arteries. Although the frequency of treating 
      infrapopliteal lesions is increasing, the reintervention rates remain high. This 
      study aimed to determine the outcomes and patency of infrapopliteal endovascular 
      reinterventions. METHODS: This retrospective, multicenter cohort study of 3 Dutch 
      hospitals included patients who underwent an endovascular infrapopliteal 
      reintervention in 2015 up to 2021 after a primary infrapopliteal intervention for 
      CLTI. The outcome measures after the reintervention procedures included technical 
      success rate, the mortality rate and complication rate (any deviation from the 
      normal postinterventional course) at 30 days, overall survival, amputation-free 
      survival (AFS), freedom from major amputation, major adverse limb event (MALE), 
      and recurrent reinterventions (a reintervention following the infrapopliteal 
      reintervention). Cox proportional hazard models were used to determine risk 
      factors for AFS and freedom from major amputation or recurrent reintervention. 
      RESULTS: Eighty-one patients with CLTI were included. A total of 87 limbs 
      underwent an infrapopliteal reintervention in which 122 lesions were treated. 
      Technical success was achieved in 99 lesions (81%). The 30-day mortality rate was 
      1%, and the complication rate was 13%. Overall survival and AFS at 1 year were 
      69% (95% confidence interval [CI], 55%-79%) and 54% (95% CI, 37%-67%), 
      respectively, and those at 2.5 years were 45% (95% CI, 33%-56%) and 21% (95% CI, 
      11%-33%), respectively. Freedom from major amputation, MALE, and recurrent 
      reinterventions at 1 year and 2.5 years were 59% (95% CI, 46%-70%) and 41% (95% 
      CI, 25%-56%); 54% (95% CI, 41%-65%) and 36% (95% CI, 21%-51%); and 68% (95% CI, 
      55%-78%) and 51% (95% CI, 33%-66%), respectively. A Global Limb Anatomic Staging 
      System score of III showed an increased hazard ratio of 2.559 (95% CI, 
      1.078-6.072; p=0.033) for freedom of major amputation or recurrent 
      reintervention. CONCLUSIONS: The results of this study indicate that endovascular 
      infrapopliteal reinterventions can be performed with acceptable 30-day mortality 
      and complication rates. However, outcomes and patency were moderate to poor, with 
      low AFS, high rates of major amputations, and recurrent reinterventions. CLINICAL 
      IMPACT: This multicenter retrospective study evaluating outcome and patency of 
      endovascular infrapopliteal reinterventions for CLTI, shows that endovascular 
      infrapopliteal reinterventions can be performed with acceptable 30-day mortality 
      and complication rates. However, the short- and mid-term outcomes of the 
      infrapopliteal reinterventions were moderate to poor, with low rates of AFS and a 
      high need for recurrent reinterventions. While the frequency of performing 
      infrapopliteal reinterventions is increasing with additional growing complexity 
      of the disease, alternative treatment options such as venous bypass grafting or 
      deep venous arterialization may be considered and should be studied in randomized 
      controlled trials.
FAU - Kleiss, Simone F
AU  - Kleiss SF
AUID- ORCID: 0000-0002-5045-2828
AD  - Division of Vascular Surgery, Department of Surgery, University Medical Center 
      Groningen, University of Groningen, Groningen, The Netherlands.
FAU - van Mierlo-van den Broek, Patricia A H
AU  - van Mierlo-van den Broek PAH
AD  - Department of Vascular Surgery, Maasstad Hospital, Rotterdam, The Netherlands.
FAU - Vos, Cornelis G
AU  - Vos CG
AD  - Department of Surgery, Martini Hospital, Groningen, The Netherlands.
FAU - Fioole, Bram
AU  - Fioole B
AUID- ORCID: 0000-0001-9945-910X
AD  - Department of Vascular Surgery, Maasstad Hospital, Rotterdam, The Netherlands.
FAU - Bloemsma, Gijs C
AU  - Bloemsma GC
AD  - Medical Imaging Center, Department of Radiology, University Medical Center 
      Groningen, University of Groningen, Groningen, The Netherlands.
FAU - de Vries-Werson, Debbie A B
AU  - de Vries-Werson DAB
AD  - Division of Vascular Surgery, Department of Surgery, University Medical Center 
      Groningen, University of Groningen, Groningen, The Netherlands.
FAU - Bokkers, Reinoud P H
AU  - Bokkers RPH
AUID- ORCID: 0000-0001-6130-7311
AD  - Medical Imaging Center, Department of Radiology, University Medical Center 
      Groningen, University of Groningen, Groningen, The Netherlands.
FAU - de Vries, Jean-Paul P M
AU  - de Vries JPM
AD  - Division of Vascular Surgery, Department of Surgery, University Medical Center 
      Groningen, University of Groningen, Groningen, The Netherlands.
LA  - eng
PT  - Journal Article
DEP - 20230107
PL  - United States
TA  - J Endovasc Ther
JT  - Journal of endovascular therapy : an official journal of the International 
      Society of Endovascular Specialists
JID - 100896915
SB  - IM
OTO - NOTNLM
OT  - chronic limb-threatening ischemia
OT  - endovascular procedures
OT  - infrapopliteal
OT  - peripheral arterial disease
OT  - reinterventions
EDAT- 2023/01/08 06:00
MHDA- 2023/01/08 06:00
CRDT- 2023/01/07 16:18
PHST- 2023/01/07 16:18 [entrez]
PHST- 2023/01/08 06:00 [pubmed]
PHST- 2023/01/08 06:00 [medline]
AID - 10.1177/15266028221147457 [doi]
PST - aheadofprint
SO  - J Endovasc Ther. 2023 Jan 7:15266028221147457. doi: 10.1177/15266028221147457.