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Long-term Clinical Outcomes and Prognostic Factors After Endovascular Treatment in Patients With Chronic Limb Threatening Ischemia

 Jung-Joon Cha  ;  Jong-Youn Kim  ;  Hyoeun Kim  ;  Young-Guk Ko  ;  Donghoon Choi  ;  Jae-Hwan Lee  ;  Chang-Hwan Yoon  ;  In-Ho Chae  ;  Cheol Woong Yu  ;  Seung Whan Lee  ;  Sang-Rok Lee  ;  Seung Hyuk Choi  ;  Yoon Seok Koh  ;  Pil-Ki Min  ;  K-VIS (Korean Vascular Intervention Society) investigators 
 KOREAN CIRCULATION JOURNAL, Vol.52(6) : 429-440, 2022-06 
Journal Title
Issue Date
Endovascular procedures ; Peripheral arterial disease ; Prognosis ; Treatment outcome
Background and objectives: Endovascular therapy (EVT) first strategy has been widely adopted for the treatment of chronic limb threatening ischemia (CLTI) patients in real-world practice. This study aimed to investigate long-term outcomes of CLTI patients who underwent EVT and identify prognostic factors.

Methods: From the retrospective cohorts of a Korean multicenter endovascular therapy registry, 1,036 patients with CLTI (792 men, 68.8 ± 9.5 years) were included. The primary endpoint was amputation-free survival (AFS) defined as the absence of major amputation or death. Secondary endpoints were major adverse limb events (MALE; a composite of major amputation, minor amputation, and reintervention).

Results: Five-year AFS and freedom from MALE were 69.8% and 61%, respectively. After multivariate analysis, age (hazard ratio [HR], 1.476; p<0.001), end-stage renal disease (ESRD; HR, 2.340; p<0.001), Rutherford category (RC) 6 (HR, 1.456; p=0.036), and suboptimal EVT (HR, 1.798; p=0.005) were identified as predictors of major amputation or death, whereas smoking (HR, 0.594; p=0.007) was protective. Low body mass index (HR, 1.505; p=0.046), ESRD (HR, 1.648; p=0.001), femoropopliteal lesion (HR, 1.877; p=0.004), RC-6 (HR, 1.471; p=0.008), and suboptimal EVT (HR, 1.847; p=0.001) were predictors of MALE. The highest hazard rates were observed during the first 6 months for both major amputation or death and MALE. After that, the hazard rate decreased and rose again after 3-4 years.

Conclusions: In CLTI patients, long-term outcomes of EVT were acceptable. ESRD, RC-6, and suboptimal EVT were common predictors for poor clinical outcomes.

Trial registration: ClinicalTrials.gov Identifier: NCT02748226.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Ko, Young Guk(고영국) ORCID logo https://orcid.org/0000-0001-7748-5788
Kim, Jong Youn(김종윤) ORCID logo https://orcid.org/0000-0001-7040-8771
Kim, Hyoeun(김효은) ORCID logo https://orcid.org/0000-0002-7334-9700
Min, Pil Ki(민필기) ORCID logo https://orcid.org/0000-0001-7033-7651
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
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