Predictors of distal embolization in peripheral percutaneous interventions: a report from a large peripheral vascular...

Distal embolization (DE) commonly occurs during peripheral percutaneous interventions (PPI) of the lower-extremity arterial vessels. In this study we evaluate the predictors of DE in a large cohort of patients undergoing PPI at our center.

Patients who experienced clinically significant DE (requiring further mechanical or pharmacologic therapy as per operator judgment) were extracted from a peripheral vascular registry that prospectively tracks demographics, clinical, procedural and outcome variables on patients undergoing PPI at our medical center and compared these to patients in the same registry who did not experience DE. Univariate analysis was utilized to compare patients with and without DE. Logistic regression analysis was performed to determine the independent predictors of DE.

Of 577 patients, 14 (2.4%) experienced clinically significant DE. By univariate analysis, patients who experienced DE had longer lesion length (130.0 +/- 123.35 mm vs. 90.05 +/- 104.94 mm; p = 0.049), more severe angiographic pretreatment lesion stenosis (91.71% +/- 14.76% vs. 85.65% +/- 14.26%; p = 0.027), reduced pretreatment TIMI flow (1.21 +/- 1.34 vs. 2.15 +/- 1.1; p = 0.001), a higher rate of prior amputations (21.4% vs. 5.9%; p = 0.052), a higher prevalence of TASC-D lesions (59.3% vs. 29.6%; p = 0.002), more angiographic thrombus (35.7% vs. 6.4%; p = 0.001), and less frequency of chronic onset of symptoms on presentation (64.3% vs. 90.6%; p = 0.009). Logistic regression analysis showed that a prior history of amputation (odds ratio [OR] 3.56, 95% confidence interval [CI] 0.87-14.47; p = 0.08), presence of thrombus (OR 5.02, 95% CI 1.53-16.42; p = 0.008) and TASC-D lesions (OR 4.31, 95% CI 1.24- 15.03; p = 0.022) were independent predictors of DE.

Clinically significant DE requiring further mechanical or pharmacologic therapy occurs in approximately 2.4% of patients undergoing PPI. Patients with TASC-D lesions, angiographic thrombus and prior history of amputation are at high risk of DE.