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Risk factors for progression to chronic limb-threatening ischemia after endovascular therapy in patients with

Keisuke Shoji1, Michitaka Kitamura1, Shiori Yoshida1

  • 1Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, Kyoto, Japan.

Vascular Medicine (London, England)
|July 16, 2025
PubMed

Insights

Peripheral artery disease patients undergoing femoropopliteal intervention face a higher risk of progressing to chronic limb-threatening ischemia (CLTI). Poor infrapopliteal runoff is a key independent predictor of this progression.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Endovascular Therapy

Background:

  • Peripheral artery disease (PAD) with de novo claudication requires effective treatment to prevent progression to chronic limb-threatening ischemia (CLTI).
  • Endovascular therapy (EVT) is a common treatment modality, particularly for femoropopliteal interventions.

Purpose of the Study:

  • To evaluate the incidence and identify risk factors for progression to CLTI in patients with PAD and claudication treated with EVT.
  • To compare the risk of CLTI progression between femoropopliteal and aortoiliac interventions.

Main Methods:

  • A cohort of 338 limbs from patients undergoing their first EVT for de novo claudication was analyzed.
  • The primary endpoint was progression to CLTI, assessed using Kaplan-Meier estimates and Cox regression for hazard ratios (HRs).

Main Results:

  • The 10-year incidence of CLTI was higher after femoropopliteal intervention (15.3%) compared to aortoiliac intervention (8.6%).
  • Significant risk factors identified included chronic kidney disease, chronic heart failure, severe calcification, P2-3 segment intervention, and poor infrapopliteal runoff.
  • Poor infrapopliteal runoff emerged as an independent predictor of CLTI progression (HR: 11.2).

Conclusions:

  • Femoropopliteal intervention for claudication carries a notable risk of progression to CLTI.
  • Comorbidities, vessel calcification, P2-3 segment involvement, and particularly poor infrapopliteal runoff are key factors influencing CLTI development.
Abstract

Keywords:
chronic limb-threatening ischemia (CLTI)endovascular therapyfemoropopliteal interventionperipheral artery disease (PAD)revascularization

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