Differences Between Patients With Intermittent Claudication and Critical Limb Ischemia Undergoing Endovascular
Kunal Patel1,2, Yulun Liu1, Farshid Etaee3
1University of Texas Southwestern Medical Center, Dallas (K.P., Y.L., M.A.A., N.M., I.T., S.B.).
Insights
Patients with critical limb ischemia (CLI) have worse outcomes than those with intermittent claudication (IC) after endovascular revascularization. CLI patients experienced higher mortality and major adverse limb events, highlighting distinct treatment needs for peripheral artery disease.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Peripheral Artery Disease Management
Background:
- Limited data exist comparing peripheral artery disease (PAD) angiographic distribution and endovascular strategies between intermittent claudication (IC) and critical limb ischemia (CLI).
- Understanding these differences is crucial for optimizing treatment and improving outcomes in PAD patients.
Purpose of the Study:
- To compare the anatomic features, endovascular treatment strategies, and clinical outcomes of patients with IC versus CLI.
- To identify disparities in revascularization approaches and associated adverse events between the two PAD severity groups.
Main Methods:
- Analysis of 3326 patients from the Excellence in Peripheral Artery Disease registry (2006-2019) undergoing endovascular intervention.
- Primary outcome: 1-year major adverse limb events (death, repeat revascularization, amputation).
- Comparison of baseline characteristics, lesion locations, intervention types, and outcomes between IC and CLI cohorts.
Main Results:
- CLI patients were older, had more comorbidities (diabetes, CKD), and received less optimal medical therapy.
- Interventions differed significantly: IC patients had more femoropopliteal interventions (87% vs 65%), while CLI patients had more below-knee (47% vs 12%) and multilevel disease (32% vs 15%).
- CLI patients had higher all-cause mortality (4% vs 2%) and 1-year major adverse limb event rates (26% vs 16%) compared to IC patients.
Conclusions:
- Significant differences exist in PAD anatomy, lesion characteristics, and endovascular treatment strategies between IC and CLI.
- Critical limb ischemia is associated with substantially higher mortality and adverse limb outcomes following endovascular revascularization compared to intermittent claudication.
Background:
There are limited data on differences in angiographic distribution of peripheral artery disease and endovascular revascularization strategies in patients presenting with intermittent claudication (IC) and critical limb ischemia (CLI). We aimed to compare anatomic features, treatment strategies, and clinical outcomes between patients with IC and CLI undergoing endovascular revascularization.
Methods:
We examined 3326 patients enrolled in the Excellence in Peripheral Artery Disease registry from 2006 to 2019 who were referred for endovascular intervention for IC (n=1983) or CLI (n=1343). The primary outcome was 1-year major adverse limb events, which included death, repeat target limb revascularization, or target limb amputation.
Results:
Patients with CLI were older and more likely to have diabetes and chronic kidney disease and less likely to receive optimal medical therapy compared with IC. Patients with IC had higher femoropopliteal artery interventions (IC 87% versus CLI 65%; P<0.001), while below the knee interventions were more frequent in CLI (CLI 47% versus IC 12%; P<0.001). Patients with CLI were more likely to have multilevel peripheral artery disease (CLI 32% versus IC 15%, P<0.001). Patients with IC were predominantly revascularized with stents (IC 48% versus CLI 37%; P<0.001) while balloon angioplasty was more frequent in CLI (CLI 37% versus IC 25%; P<0.001). All-cause mortality was higher in patients with CLI (CLI 4% versus IC 2%; P=0.014). Major adverse limb event rates for patients with IC and CLI were 16% and 26%, respectively (P<0.001) and remained higher in CLI after multivariable adjustment of baseline risk factors.
Conclusions:
Patients with IC and CLI have significant anatomic, lesion, and treatment differences with significantly higher mortality and adverse limb outcomes in CLI. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01904851. Graphic Abstract: A graphic abstract is available for this article.
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