title: Inflammatory burden predicts long-term outcomes in endovascular therapy in peripheral arterial disease.
abstract: BACKGROUND
  Peripheral arterial disease (PAD) is a systemic inflammatory disorder that affects the entire vascular system. Endovascular therapy (EVT) is the first surgical treatment choice in a large number of patients who suffer from this disease. However, late clinical failure after primarily successful interventions, with the need of a new reintervention, is the major drawback of this technique. The aim of this study is to determine the possible association between serum high sensitivity C-reactive protein (hsCRP) and fibrinogen levels both preintervention and during follow-up, and the outcomes of EVT and their association with the incidence of cardiovascular events or death in these patients.
  
  
  METHODS
  This is a prospective cohort study in patients diagnosed with PAD in the iliac, femoral, popliteal, or distal sectors, within Rutherford category 3-5 who underwent EVT de novo. We determined levels of hsCRP and fibrinogen before surgery and during the follow-up period (at 1, 3, 6, and 12 months). We analyzed the possible association among inflammatory markers levels before EVT, during 1 year of follow-up and its variation during that year, and the incidence of reintervention, reintervention-free survival, and the occurrence of cardiovascular events or death.
  
  
  RESULTS
  Over the course of 1 year, 246 patients underwent a revascularizing treatment of the lower limbs; 64 patients qualified for inclusion in this study. In these 64 patients, a significant increase between basal hsCRP and fibrinogen levels and the incidence of reintervention (P=0.002 and 0.013, respectively) and death (P=0.001 and 0.013, respectively) during follow-up was found. A significant increase between higher hsCRP basal levels and the incidence of cardiovascular events during the follow-up period was also noted (P=0.004). Levels of basal hsCRP were related to reintervention-free survival after EVT (P=0.04). On the basis of the rate of hsCRP variation and its association with reintervention-free survival, we observed a progressive reduction of the levels of hsCRP until 12 months after the primary procedure.
  
  
  CONCLUSIONS
  Basal levels of inflammatory markers and their variation during follow-up allowed us to identify a subgroup of patients with PAD that will require a greater number of (and earlier) reinterventions after EVT and who will have higher rates of cardiovascular morbidity and mortality.
authors: Department of Angiology and Vascular Surgery, Hospital Universitario de Getafe, Madrid, Spain. silbleik@yahoo.es
authors: Silvia
authors: S
authors: Bleda
authors: Joaquin
authors: J
authors: De Haro
authors: Francisco
authors: F
authors: Acin
authors: Cesar
authors: C
authors: Varela
authors: Leticia
authors: L
authors: Esparza
authors: Ignacio
authors: I
authors: López de Maturana
mesh_terms: D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D057510:Endovascular Procedures / Q000379:methods*; D005340:Fibrinogen / Q000378:metabolism*; D005500:Follow-Up Studies; D006801:Humans; D016491:Peripheral Vascular Diseases / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014657:Vasculitis / Q000097:blood / Q000150:complications* / Q000175:diagnosis
chemical_list: D015415:Biomarkers; D005340:Fibrinogen; D002097:C-Reactive Protein