Korean Circ J.  2022 Jun;52(6):429-440. 10.4070/kcj.2021.0342.

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

• Cha JJ
• Kim JY
• Kim H
• Ko YG
• Choi D
• Lee JH
• Yoon CH
• Chae IH
• Yu CW
• Lee SW
• Lee SR
• Choi SH
• Koh YS
• Min PK
• on behalf of the K-VIS (Korean Vascular Intervention Society) investigators

• KMID: 2530447
• DOI: http://doi.org/10.4070/kcj.2021.0342

Abstract

Background and Objectives
Endovascular therapy (EVT) first strategy has been widely adopted for the treatment of chronic limb threatening ischemia (CLTI) patients in realworld 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.

Keyword

Peripheral arterial disease; Endovascular procedures; Treatment outcome; Prognosis

Figure

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  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.

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  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.

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