Outcomes For Endovascular Tibial Interventions For Claudication And Rest Pain
Tigran Divanyan, MD, Nicholas Russo, MD, Misak Harutyunyan, MD, Neil Patel, MS, R Clement Darling, III, MD, Jeffrey Hnath, MD.
Albany Medical Center Hospital, Albany, NY, USA.
Introduction: Endovascular intervention of infra-geniculate arteries has been a vital tool for treating lower extremity occlusive disease in the setting of tissue loss. Claudication (CLAUD) and ischemic rest pain (RST) patients may require longer term vessel patency for symptomatic relief compared to limbs that may only need a short period of improved blood flow for tissue healing. The purpose of this study is to evaluate the outcomes of endovascular treatment of tibial arterial disease in the setting of claudication and rest pain. Methods:A single vascular group’s database was queried for all patients who received a tibial artery endovascular intervention from 2011-2019. Interventions were either angioplasty alone or atherectomy with angioplasty. Demographics, indications, and long-term results were recorded and compared. Groups were compared utilizing standard statistics. Results: Between 2011 and 2019 there were 230 endovascular tibial interventions (113 CLAUD vs 117 RST). Demographics for CLAUD and RST were similar: age (71.3, range 52-94 vs 71.7, range 29-98 p=.78), male (72 vs 69 p=.87). Mean follow-up was longer for CLAUD than RST (926 vs 615 months, p=.0003). Rates of diabetes, hypertension, coronary disease, tobacco use, hyperlipidemia, and renal failure were similar. Index atherectomy rates for CLAUD and RST were similar (79, 69.9% vs 76, 65% p=0.87). CLAUD and RST had similar re-intervention rates (41, 36.3% vs 56, 47.9% p=.36). Groups had similar rates of initial endovascular only re-interventions (23, 20.4% vs 20, 17.1% p=0.76), whereas RST trended a higher rate of open only re-interventions (19, 16.2% vs 8, 7% p=0.054). RST had a higher average of open and endovascular interventions per person (3.2 vs 2.4 p<0.0001). Major amputation rate was similar between CLAUD and RST (2, 2.7% vs 8, 6.8% p=0.22). 1, 2, 5, 10-year survival rates for the claudication cohort were 97.3%, 94.7%, 86.7%, and 83.2% respectively, while survival rates for the rest pain cohort were 80.3%, 74.4%, 60.7%, and 58.1% respectively (p-value < 0.0001). Conclusion: Tibial vessel endovascular intervention remains an effective and viable option for patients with symptomatic infra-geniculate disease. Patients presenting with rest pain had similar amputation rates as claudicants, however required more interventions and had lower survival rates. Following risk factor modification and a trial of graded exercise this may be a non-invasive option for claudicants.
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