Multiple Reinterventions for Claudication are Associated with Progression to Chronic Limb-Threatening Ischemia

Area of Science:

• Vascular Surgery
• Cardiology
• Interventional Radiology

Background:

• Claudication typically has a favorable prognosis with low limb loss risk.
• Progression to chronic limb-threatening ischemia (CLTI) after lower extremity revascularization (LER) for claudication is not well-defined.
• This study investigates long-term outcomes and risk factors for CLTI development post-LER in claudication patients.

Purpose of the Study:

• To determine the incidence and long-term outcomes of CLTI progression after LER for claudication.
• To identify risk factors associated with the progression from claudication to CLTI.
• To analyze the impact of reinterventions and prior procedures on CLTI development.

Main Methods:

• Retrospective review of 448 patients (502 limbs) undergoing LER for claudication (2013-2016).
• Stratification of patients into groups based on progression to CLTI.
• Multivariable logistic regression analysis to identify independent risk factors.

Main Results:

• 12.7% of patients progressed to CLTI over a mean follow-up of 3.7 years.
• Progression to CLTI was associated with a history of congestive heart failure, stroke, and prior open revascularizations.
• Increased number of reinterventions after index LER was a significant predictor of CLTI development.

Conclusions:

• Multiple reinterventions and previous open revascularization are key risk factors for CLTI progression post-LER.
• Patients with concurrent coronary and cerebrovascular atherosclerosis face a higher risk of claudication progressing to CLTI.
• Enhanced surveillance and risk factor management are crucial for patients undergoing LER for claudication.