Long-term Clinical Outcomes and Prognostic Factors After Endovascular Treatment in Patients With Chronic Limb Threatening Ischemia
- Authors
- Cha, Jung-Joon; Kim, Jong-Youn; Kim, Hyoeun; Ko, Young-Guk; Choi, Donghoon; Lee, Jae-Hwan; Yoon, Chang-Hwan; Chae, In-Ho; Yu, Cheol Woong; Lee, Seung Whan; Lee, Sang-Rok; Choi, Seung Hyuk; Koh, Yoon Seok; Min, Pil-Ki; Korean Vascular Intervention Society Investigators
- Issue Date
- Jun-2022
- Publisher
- 대한심장학회
- Keywords
- Peripheral arterial disease; Endovascular procedures; Treatment outcome; Prognosis
- Citation
- Korean Circulation Journal, v.52, no.6, pp 429 - 440
- Pages
- 12
- Indexed
- SCIE
SCOPUS
KCI
- Journal Title
- Korean Circulation Journal
- Volume
- 52
- Number
- 6
- Start Page
- 429
- End Page
- 440
- URI
- https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/61112
- DOI
- 10.4070/kcj.2021.0342
- ISSN
- 1738-5520
1738-5555
- 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
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