Influence of Target Lesion Locations on Clinical Outcomes After Endovascular Therapy in Patients With Peripheral Artery Disease

초록

Background The difference in long-term prognosis according to the target lesion location in patients with peripheral arterial disease (PAD) is still controversial. The aim of this study was to assess the influence of therapeutic target lesion locations on long-term clinical outcomes after endovascular therapy (EVT) in patients with PAD. Methods From the retrospective cohorts of a Korean multicenter endovascular therapy registry, 2,532 patients with PAD (2,078 men, mean age 68.4 ± 9.6 years) who underwent initial EVT were included. The subjects were divided according to target lesion locations: aortoiliac (AI), femoropopliteal (FP), and infrapopliteal (IP). The primary endpoint was major adverse cardiovascular events (MACE; death, myocardial infarction, and stroke) during the 5-year follow-up period. Results Among 2,532 patients with de novo PAD, including 787 patients with chronic limb-threatening ischemia, AI disease, FP disease, and IP disease were noted in 1,198 (47.3%), 1,253 (49.5%), and 705 (27.8%) patients, respectively. Event-free survival according to lesion location was not different in patients with single-level disease (n = 1,941). When survival analyses were performed separately according to the presence or absence of lesion at 1 of 3 predefined target lesion locations, patients with FP or IP disease had more events during follow-up than patients without FP or IP disease, respectively. However, patients with AI disease showed fewer MACE during follow-up than patients without AI disease. Patients with multilevel disease showed worse outcomes in terms of MACE than patients with single-level disease ( P = 0.008). However, after multivariate analysis, the presence of FP or IP disease or multilevel disease was not a significant predictor of MACE. Old age, end-stage renal disease, congestive heart failure, stroke history, and chronic limb-threatening ischemia were identified as independent predictors of MACE. Conclusions In patients with PAD who underwent EVT, long-term outcomes were largely defined by the conventional risk factors or underlying comorbidities rather than the target lesion location.