Platelet antiaggregation therapy and subinguinal endovascular revascularization

Platelet antiaggregation therapy (PAT) is widely acknowledged to be a positive prognostic factor after revascularization, either at the coronary or the peripheral level. This study evaluated the results of infrainguinal endovascular procedures performed for critical ischemia, in accordance with patient compliance to clopidogrel treatment.

This retrospective study included patients who underwent infrainguinal endovascular therapy for critical ischemia between January 2003 and December 2009. For 1 month, patients received the same postoperative PAT protocol: aspirin associated with clopidogrel, and then clopidogrel in the long term. Patient follow-up was set at 3 months, 6 months, 1 year, and then yearly thereafter. Survival rates, primary patency (PP), and limb salvage (LS) were studied in accordance with therapy compliance. Patients were classified into 2 groups: group 1 for compliant patients and group 2 for noncompliant patients in the long term. From January 2003 to December 2009, 153 infrainguinal endovascular procedures were performed on 150 patients experiencing critical ischemia who had benefited from the authors' postoperative PAT protocol.

Both groups were comparable in terms of comorbidity. Of the procedures performed in groups 1 (N = 105) and 2 (N = 45), 62.8% (n = 66) and 44.4% (n = 20), respectively, were femoral, 14.3% (n = 15) and 22.2% (n = 10), respectively, were infrapopliteal, and 22.9% (n = 24) and 33.4% (n = 15), respectively, were mixed. Mean follow-up time was 30.3 ± 20.2 months (range, 1-70 months). The survival rate was comparable between the groups (P = 0.46). PP and LS rates were significantly higher in group 1 than in group 2 (PP: 84% vs. 80%, respectively, at 1 year, 79% vs. 50%, respectively, at 2 years, 65% vs. 30%, respectively, at 3 years, and 60% vs. 18%, respectively, at 4 years; P = 0.02; LS: 92% vs. 78%, respectively, at 1 year, 86% vs. 62%, respectively, at 2 years, 80% vs. 55%, respectively, at 3 years, and 77% vs. 36%, respectively, at 4 years; P = 0.04).

This study shows that in common practice, 31% of patients stop their clopidogrel therapy, with a negative impact on PP and LS. These results indicate that medical follow-up after endovascular surgery must be reinforced.