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OBJECTIVES:
The effects of concomitant endovascular interventions on multiple infrapopliteal vessels are not well known and the long-term sequelae of such procedures have not been reported.
METHODS:
From 2004 to 2014, 673 patients underwent an infrapopliteal endovascular intervention for tissue loss (77%), rest pain (13%), stenosis of a previously treated vessel (5%), acute limb ischemia (3%), or claudication (2%). Data collected included RAS events (revascularization, major amputation, or stenosis [>3.5x step-up by duplex]) and wound healing. Patients without an initial indication of Critical Limb Ischemia (CLI) were excluded. Patients were characterized by single-vessel infrapopliteal interventions and multiple-vessel infrapopliteal interventions. Worsened Rutherford class between index procedure and failure was also noted.
RESULTS:
Of the 673 patients, 596 underwent an infrapopliteal endovascular intervention for CLI: 85% for tissue loss and 15% for rest pain. During a single procedure, 533 (89%) patients underwent a single-vessel intervention while 63 (11%) patients underwent a multiple-vessel intervention. Patients undergoing a single-vessel intervention had more commonly experienced a prior ipsilateral endovascular procedure (17% vs. 10%, P=.04) while patients undergoing a multiple-vessel intervention more often suffered from diabetes (78% vs. 89%, P=.03) and were more often discharged to a rehab facility (33% vs. 41%, P=.04). Survival analysis revealed no difference in the proportion of patients experiencing a restenosis (P=.11). A Cox regression model illustrated that long-term outcomes do not differ between patients undergoing a multiple-vessel intervention versus those undergoing a single-vessel intervention. Among the 596 patients, a RAS event occurred in 284 limbs (48%) and there was no significant difference in the rate of RAS events between single and multiple-vessel infrapopliteal interventions (48% vs. 49%, p=.84). Amputation rate also did not significantly differ between the two groups (14% vs. 16%, P=.71). In both groups, 8% of RAS patients presented with a worse ischemia class as compared to their initial symptoms.
CONCLUSIONS:
Our data suggest that multiple-vessel intervention does not improve outcomes as compared to single-vessel intervention following any infrapopliteal procedure for CLI.