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Patel K, Liu Y, Etaee F, Patel C, Monteleone P, Patel M, Amer Alaiti M, Metzger C, Banerjee A, Minniefield N, Tejani I, Brilakis ES, Shishehbor MH, Banerjee S. Differences Between Patients With Intermittent Claudication and Critical Limb Ischemia Undergoing Endovascular Intervention: Insights From the Excellence in Peripheral Artery Disease Registry. Circ Cardiovasc Interv 2021; 14:e010635. [PMID: 34706553 DOI: 10.1161/circinterventions.121.010635] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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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Affiliation(s)
- Kunal Patel
- University of Texas Southwestern Medical Center, Dallas (K.P., Y.L., M.A.A., N.M., I.T., S.B.).,Veterans Affairs North Texas System, Dallas (K.P., C.P., M.A.A., N.M., I.T., S.B.)
| | - Yulun Liu
- University of Texas Southwestern Medical Center, Dallas (K.P., Y.L., M.A.A., N.M., I.T., S.B.)
| | - Farshid Etaee
- Texas Tech University Health Sciences Center, Amarillo School of Medicine (F.E.)
| | - Chirag Patel
- Veterans Affairs North Texas System, Dallas (K.P., C.P., M.A.A., N.M., I.T., S.B.).,Methodist Health System Dallas, TX (C.P.)
| | | | - Mitul Patel
- University of California San Diego Sulpizio Cardiovascular Center, La Jolla (M.P.)
| | - Mohamad Amer Alaiti
- University of Texas Southwestern Medical Center, Dallas (K.P., Y.L., M.A.A., N.M., I.T., S.B.).,Veterans Affairs North Texas System, Dallas (K.P., C.P., M.A.A., N.M., I.T., S.B.)
| | | | | | - Nicole Minniefield
- University of Texas Southwestern Medical Center, Dallas (K.P., Y.L., M.A.A., N.M., I.T., S.B.).,Veterans Affairs North Texas System, Dallas (K.P., C.P., M.A.A., N.M., I.T., S.B.)
| | - Ishita Tejani
- University of Texas Southwestern Medical Center, Dallas (K.P., Y.L., M.A.A., N.M., I.T., S.B.).,Veterans Affairs North Texas System, Dallas (K.P., C.P., M.A.A., N.M., I.T., S.B.)
| | | | - Mehdi H Shishehbor
- Case Western Reserve University and Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH (M.H.S.)
| | - Subhash Banerjee
- University of Texas Southwestern Medical Center, Dallas (K.P., Y.L., M.A.A., N.M., I.T., S.B.).,Veterans Affairs North Texas System, Dallas (K.P., C.P., M.A.A., N.M., I.T., S.B.)
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Heideman PP, Rajebi MR, McKusick MA, Bjarnason H, Oderich GS, Friese JL, Fleming MD, Stockland AH, Harmsen WS, Mandrekar J, Misra S. Impact of Chronic Kidney Disease on Clinical Outcomes of Endovascular Treatment for Femoropopliteal Arterial Disease. J Vasc Interv Radiol 2016; 27:1204-14. [PMID: 27321888 DOI: 10.1016/j.jvir.2016.04.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 04/28/2016] [Accepted: 04/30/2016] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To evaluate effect of chronic kidney disease (CKD) on all-cause mortality, major adverse limb event (MALE), MALE and postoperative death (MALE + POD), and amputation after endovascular treatment of femoropopliteal disease. MATERIALS AND METHODS A retrospective review from January 2002 to October 2011 was performed of 440 patients who underwent endovascular treatment of symptomatic femoropopliteal disease for claudication (n = 251) or critical limb ischemia (CLI) (n = 267). CKD stage was divided based on Kidney Dialysis Outcomes Quality Initiative classification. Outcomes and factors associated with amputation, MALE, and MALE + POD were determined. RESULTS Patients with diabetes (hazard ratio [HR] = 2.2; 95% confidence interval [CI], 1.3-3.6; P = .002) and runoff score of 0 or 1 (HR = 2.0; 95% CI, 1.2-3.4; P = .01) relative to runoff score of 3 were at increased risk of amputation. Patients with baseline glomerular filtration rate < 45 mL/min/1.73 m(2) had a 17% increase in amputation for every 5-point decrease < 45 mL/min/1.73 m(2) (95% CI, 1.09-1.26; P < .001). Increase of 10 years in age (HR = 1.9; 95% CI, 1.5-2.3; P < .001), TransAtlantic Inter-Society Consensus class of C/D relative to A/B (HR = 1.6; 95% CI, 1.1-2.2; P = .01), and CLI (HR = 2.4; 95% CI, 0.5-0.9; P < .001) were associated with increased mortality. Female sex was associated with decreased risk of mortality (HR = 0.7; 95% CI, 0.5-0.9; P = .01). CONCLUSIONS Worsening CKD is associated with higher amputation rates, all-cause mortality, and MALE + POD in patients undergoing endovascular treatment of femoropopliteal disease.
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Affiliation(s)
- Paul P Heideman
- Division of Vascular and Interventional Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Mohammad Reza Rajebi
- Division of Vascular and Interventional Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Michael A McKusick
- Division of Vascular and Interventional Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Haraldur Bjarnason
- Division of Vascular and Interventional Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Gustavo S Oderich
- Department of Radiology, Division of Vascular and Endovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Jeremy L Friese
- Division of Vascular and Interventional Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Mark D Fleming
- Department of Radiology, Division of Vascular and Endovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Andrew H Stockland
- Division of Vascular and Interventional Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - William S Harmsen
- Biomedical Statistics and Informatics, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Jay Mandrekar
- Biomedical Statistics and Informatics, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Sanjay Misra
- Division of Vascular and Interventional Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; Vascular and Interventional Radiology Translational Laboratory, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
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Marmagkiolis K, Hakeem A, Choksi N, Al-Hawwas M, Edupuganti MMR, Leesar MA, Cilingiroglu M. 12-month primary patency rates of contemporary endovascular device therapy for femoro-popliteal occlusive disease in 6,024 patients: beyond balloon angioplasty. Catheter Cardiovasc Interv 2014; 84:555-64. [PMID: 24740749 DOI: 10.1002/ccd.25510] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 02/27/2014] [Accepted: 04/06/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Endovascular approach to superficial femoral artery (SFA) disease, the most common cause of symptomatic peripheral arterial disease, remains fraught with high failure rates. Newer devices including second-generation nitinol stents, drug-coated stents, drug-coated balloons, covered stents, cryo-therapy, LASER, and directional atherectomy have shown promising results. Clinical equipoise still persists regarding the optimal selection of devices, largely attributable to the different inclusion criteria, study population, length of lesions treated, definition of "patency" and "restenosis," and follow-up methods in the pivotal trials. METHODS A prospective protocol was developed. We performed a literature search using PubMed from January 2006 to November 2013. Published articles including endovascular interventions in SFA or popliteal arteries with reported 12-month "primary patency" or "binary restenosis" rates as endpoints were included. RESULTS We identified 6,024 patients in 61 trials reporting 12-month primary patency rates in patients with femoropoliteal disease. Primary patency rates were (weighted average) 77.2% for nitinol stents, 68.8% for covered stents, 84% for drug eluting stents, 78.2% for drug eluting/coated balloon, 60.7% for cryoballoon, 51.1% for LASER atherectomy, 63.5% for directional atherectomy and 70.2% with a combination of endovascular devices. CONCLUSION The most frequently used endovascular devices yielded various 12-month primary patency rates ranging from 51% to 85%. The increased variation in inclusion criteria, length, and complexity of lesions between studies does not allow direct comparison between them. Larger randomized trials in specific patient populations comparing those modalities is needed before we can make safe recommendation of the superiority of one device over the other.
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Chang SH, Tsai YJ, Chou HH, Wu TY, Hsieh CA, Cheng ST, Huang HL. Clinical Predictors of Long-Term Outcomes in Patients With Critical Limb Ischemia Who have Undergone Endovascular Therapy. Angiology 2013; 65:315-22. [DOI: 10.1177/0003319713515544] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Clinical predictors of long-term outcomes in patients with critical limb ischemia (CLI) treated with endovascular therapy (EVT) remain unclear. In this study, clinical predictors of long-term outcomes in EVT-treated patients with CLI were investigated. In this prospective, observational study, we analyzed a total of 253 Taiwanese patients with CLI with 314 limbs who underwent EVT between 2005 and 2012. Cox models were used to estimate hazard ratios of death, limb loss, and sustained clinical success (SCS). Multivariate analysis showed that age, atrial fibrillation (AF), end-stage renal disease (ESRD), and albumin were significant predictors of mortality. Patients with coronary artery disease and low albumin levels had a significant risk of major limb amputation, while AF, ESRD, and albumin were significant, independent predictors of SCS. In addition to previously reported predictors, we showed that AF and malnutrition can be used to predict long-term outcome in EVT-treated patients with CLI.
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Affiliation(s)
- Shang-Hung Chang
- Section of Cardiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yueh-Ju Tsai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsin-Hua Chou
- Department of Internal Medicine, Section of Cardiology, Taipei Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Taiwan
| | - Tien-Yu Wu
- Department of Internal Medicine, Section of Cardiology, Taipei Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Taiwan
| | - Chien-An Hsieh
- Department of Internal Medicine, Section of Cardiology, Taipei Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Taiwan
| | - Shih-Tsung Cheng
- Department of Internal Medicine, Section of Cardiology, Taipei Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Taiwan
| | - Hsuan-Li Huang
- Department of Internal Medicine, Section of Cardiology, Taipei Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Taiwan
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Misra S, Lookstein R, Rundback J, Hirsch AT, Hiatt WR, Jaff MR, White CR, Conte M, Geraghty P, Patel M, Rosenfield K. Proceedings from the Society of Interventional Radiology research consensus panel on critical limb ischemia. J Vasc Interv Radiol 2013; 24:451-8. [PMID: 23522155 DOI: 10.1016/j.jvir.2012.10.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 10/19/2012] [Accepted: 10/22/2012] [Indexed: 12/20/2022] Open
Affiliation(s)
- Sanjay Misra
- Department of Radiology, Division of Vascular and Interventional Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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