Objective performance goals after endovascular intervention for critical limb ischemia

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Peripheral Artery Disease Management

Background:

• Primary endoluminal therapy for critical limb ischemia (CLI) has increased significantly over the past decade.
• Patient-centered outcomes reporting using Society for Vascular Surgery objective performance goals (OPGs) for CLI is limited.

Purpose of the Study:

• To examine the objective performance goals (OPGs) for infrainguinal endovascular management of critical limb ischemia (CLI).

Main Methods:

• A prospective database of 728 patients undergoing endovascular treatment for CLI between 2000 and 2011 was queried.
• Evaluated outcomes included clinical efficacy, amputation-free survival, and freedom from major adverse limb events (MALEs).

Main Results:

• Technical success was 96%, with 3% major adverse cardiovascular events (MACEs) and 12% MALEs at 30 days.
• At 5 years, clinical efficacy was 42%, amputation-free survival was 41%, and freedom from MALEs was 51%.
• Tissue loss and anatomic risk factors negatively impacted outcomes.

Conclusions:

• Endoluminal therapy for CLI has low early MACE rates but high MALE rates.
• Longer-term outcomes after endovascular intervention for CLI remain relatively poor, with less than 40% success in objective performance outcomes at 5 years.
• Predictors of better amputation-free survival include non-smoking status, lower amputation risk scores, better preoperative ambulation, and home discharge.