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Published on: September 22, 2020
Cardiovascular risk factors do not predict clinically defined restenosis after percutaneous transluminal angioplasty
Heiko Alfke1, Jens J Froelich, Severin Nowak
1Department of Radiology, University Hospital, Philipps University Marburg, Germany. alfke@mailer.uni-marburg.de
Insights
Diabetes mellitus, poor runoff, and multiple treated lesions predict lower patency after lower limb angioplasty. These factors are crucial for managing restenosis risk and improving outcomes in patients undergoing this procedure.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Imaging
Background:
- Percutaneous transluminal angioplasty (PTA) is a common treatment for lower limb ischemia.
- Restenosis and loss of primary patency are significant complications affecting long-term outcomes.
- Identifying risk factors is crucial for patient selection and procedural optimization.
Purpose of the Study:
- To evaluate risk factors predicting restenosis and primary patency after successful PTA for lower limb ischemia.
- To analyze the impact of patient history, clinical data, and angiographic findings on PTA outcomes.
Main Methods:
- Retrospective analysis of 137 patients (148 extremities) who underwent successful PTA.
- Data collection included cardiovascular risk factors (SCVIR criteria), clinical data, patient history, and telephone interviews.
- Angiograms were evaluated for lesion length, number, type (SCVIR score), and runoff.
- Outcomes were categorized into early (<1 month), mean (1-6 months), and late (>6 months) recurrence, or no recurrence.
Main Results:
- Higher diabetes scores were observed in early recurrence (group I) compared to no recurrence (group IV) (p=0.002).
- Worse runoff was noted in group I compared to group IV (p=0.008).
- Stepwise multiple regression identified diabetes mellitus (p<0.001), runoff (p=0.005), and number of treated lesions (p=0.007) as predictors for lower primary patency.
Conclusions:
- Diabetes mellitus, poor runoff, and a higher number of treated lesions are significant predictors of lower primary patency after PTA for lower limb ischemia.
- No specific risk factor profile was identified for clinically defined restenosis in this study.
- These findings highlight the importance of managing diabetes and optimizing angioplasty techniques to improve long-term patency rates.
Abstract:
The purpose of this study was to evaluate risk factors predicting restenosis and primary patency after percutaneous transluminal angioplasty. Follow-up data (including cardiovascular risk factor scores according to SCVIR criteria, preinterventional and postinterventional clinical data and patient history) of all patients who underwent successful percutaneous transluminal angioplasty for lower limb ischemia were analyzed retrospectively and patients, relatives, or referring physicians underwent a telephone interview. Patients with incomplete follow-up data were examined by means of a clinical examination, including Doppler measurements and treadmill test. Additionally all angiograms were evaluated to calculate lesion length, number of treated lesions, lesion type (SCVIR score), and runoff. The outcome was categorized into four groups: early recurrence (< 1 month, group I), mean recurrence (1-6 months, group II), late recurrence (>6 months, group III), and no recurrence (group IV). According to common concepts group I was defined as early (thrombotic) reocclusion, group II as clinically defined restenosis, and group III as progression of atherosclerosis. One hundred thirty-seven patients underwent percutaneous transluminal angioplasty of 148 extremities. The groups differ significantly only with respect to a higher diabetes score for group I in comparison to group IV (p=0.002, Kruskal-Wallis test), and a worse runoff of group I compared with group IV (p =0.008). There was a trend toward a higher diabetes score for group II in comparison to group IV (p = 0.014). There were no differences with regard to hyperlipemia, hypertension, and tobacco use between patient groups. Mean primary patency was 436 days. Predictors for lower patency rates were diabetes mellitus (p<0.001), runoff (p=0.005), and number of treated lesions (p=0.007) in a stepwise, multiple regression analysis. Patients with clinically defined restenosis showed no specific risk factor profile in this study. Predictors for lower primary patency were diabetes mellitus, number of treated lesions, and runoff.
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