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Cardiovascular Outcomes After Lower Extremity Endovascular or Surgical Revascularization: The EUCLID Trial

Iris Baumgartner1, Lars Norgren2, F Gerry R Fowkes3

  • 1Swiss Cardiovascular Centre, Inselspital, Division of Angiology, Bern University Hospital, University of Bern, Bern, Switzerland.

Journal of the American College of Cardiology
|September 29, 2018
PubMed

Insights

Lower extremity revascularization (LER) in peripheral artery disease (PAD) patients increased risks for major cardiovascular events and major adverse limb events (MALE). Endovascular LER was most common, but both surgical and endovascular procedures carried significant risks.

Area of Science:

  • Vascular Surgery
  • Cardiology
  • Clinical Trials

Background:

  • Peripheral artery disease (PAD) management often involves lower extremity revascularization (LER).
  • Long-term outcomes and predictors of LER in PAD patients remain incompletely understood.
  • The EUCLID trial provides a platform to investigate LER outcomes in a large PAD cohort.

Purpose of the Study:

  • To analyze lower extremity revascularization (LER) in the EUCLID trial.
  • To identify predictors of LER in patients with peripheral artery disease (PAD).
  • To evaluate cardiovascular and limb-related outcomes following LER.

Main Methods:

  • Analysis of patients undergoing post-randomization LER (n=1,738) versus no LER (n=12,147) from the EUCLID trial.
  • Assessment of independent predictors for LER using univariable and multivariable models.
  • Primary endpoint: myocardial infarction, ischemic stroke, or cardiovascular death. Major adverse limb events (MALE): acute limb ischemia or major amputation.

Main Results:

  • Post-randomization LER occurred in 12.5% of patients, predominantly endovascular (74.7%).
  • Independent LER predictors included prior LER, geographic region, limb symptoms, diabetes, and smoking.
  • LER was associated with increased risk for primary endpoint (HR 1.60) and MALE (HR 12.0).

Conclusions:

  • Lower extremity revascularization (LER) in PAD patients, most often endovascular, is linked to higher risks of cardiovascular events and MALE.
  • Surgical LER showed numerically higher primary endpoint event rates, while MALE rates were similar between endovascular and surgical approaches.
  • These findings highlight the significant risks associated with LER in PAD patients, underscoring the need for careful consideration of treatment strategies.
Abstract

Keywords:
acute limb ischemiacardiovascular eventdiabeteslower extremity revascularizationperipheral artery diseasesmoking

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