Clinical results of single-vessel versus multiple-vessel infrapopliteal intervention
Jeremy D Darling1, John C McCallum1, Peter A Soden1
1Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
Insights
Performing endovascular interventions on multiple infrapopliteal vessels for critical limb ischemia (CLI) showed no improved outcomes compared to single-vessel interventions. This study found similar rates of reintervention, major amputation, and stenosis between single and multiple vessel interventions.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Critical Limb Ischemia
Background:
- The outcomes of endovascular interventions on multiple infrapopliteal vessels are not well-documented.
- Short-term and long-term sequelae of these procedures require further investigation.
Purpose of the Study:
- To evaluate the effects of concomitant endovascular interventions on multiple infrapopliteal vessels.
- To compare outcomes between single-vessel and multiple-vessel infrapopliteal interventions in patients with critical limb ischemia.
Main Methods:
- A retrospective analysis of 673 limbs in 528 patients who underwent infrapopliteal endovascular intervention between 2004 and 2014.
- Patients were categorized into single-vessel or multiple-vessel intervention groups.
- Outcomes assessed included wound healing, restenosis (RAS) events, major amputation, reintervention, and mortality.
Main Results:
- A total of 558 limbs underwent successful intervention for critical limb ischemia (CLI).
- 90% of interventions involved a single vessel, while 10% involved multiple vessels.
- Kaplan-Meier analysis and multivariable regression showed no significant difference in 1-year rates of reintervention, major amputation, or restenosis between single-vessel and multiple-vessel interventions.
Conclusions:
- Multiple-vessel infrapopliteal endovascular intervention does not appear to offer improved outcomes compared to single-vessel intervention for CLI.
- The findings suggest that the number of vessels treated in a single infrapopliteal endovascular procedure does not significantly impact key clinical outcomes.
Objective:
The effects of concomitant endovascular interventions on multiple infrapopliteal vessels are not well known, and the short-term and long-term sequelae of such procedures have not been reported.
Methods:
From 2004 to 2014, 673 limbs in 528 patients underwent an infrapopliteal endovascular intervention for tissue loss (77%), rest pain (13%), stenosis of a previously treated vessel (5%), acute limb ischemia (3%), or claudication (2%). Outcomes included wound healing, RAS events (reintervention, major amputation, or stenosis [>3.5x step-up by duplex]), and mortality. Patients without an initial indication of critical limb ischemia (CLI) were excluded. Patients were characterized as having undergone either a single-vessel infrapopliteal intervention or a multiple-vessel infrapopliteal intervention.
Results:
Of the 673 limbs, 558 underwent a successful infrapopliteal endovascular intervention for CLI (86% for tissue loss, 14% for rest pain). During a single procedure, 503 limbs (90%) underwent a single-vessel intervention and 55 (10%) underwent a multiple-vessel intervention. Patients undergoing a single-vessel intervention more commonly underwent a prior ipsilateral endovascular procedure (17% vs 6%; P = .03) or a prior ipsilateral bypass procedure (20% vs 9%; P = .04). Kaplan-Meier analysis revealed that a RAS event ≤1 year occurred in 229 limbs (49%), with no significant difference in the 1-year rates of reintervention (22% vs 20%; P = .53), major amputation (16% vs 10%; P = .24), or stenosis (29% vs 21%; P = .25). After adjustment for baseline characteristics, multivariable regression illustrated that neither major amputation rates nor RAS events differed between patients undergoing a single-vessel vs a multiple-vessel intervention (P = .26 and P = .61, respectively).
Conclusions:
Our data suggest that a multiple-vessel intervention does not improve outcomes when compared to a single-vessel intervention following infrapopliteal angioplasty for CLI.
