title: Five-year prognosis after endovascular therapy in claudicant patients with iliofemoral artery disease.
abstract: OBJECTIVE
  To examine the prognosis of patients with intermittent claudication who received treatment with endovascular techniques.
  
  
  METHODS
  A retrospective multicenter study was performed involving 2930 consecutive patients (2307 men; mean age 71.5±8.9 years) with intermittent claudication who underwent an endovascular procedure for a de novo iliofemoral artery lesion. The primary outcome measure was overall survival. The secondary outcomes were freedom from major adverse cardiovascular events (MACE: all-cause death, myocardial infarction, and stroke) and from major adverse cardiovascular and limb events (MACE with repeat revascularization or above-knee amputation of the target limb). Cox multivariate regression analysis of selected baseline characteristics, procedure-related complications, and medication use was performed to determine predictors for all-cause mortality. Positive predictors from this analysis were used to stratify patients into low- (1410, 48.1%), moderate- (1406, 48.0%), and high-risk (114, 3.9%) categories.
  
  
  RESULTS
  The overall survival rates were 97.2%, 90.8%, and 83.4% at 1, 3, and 5 years, respectively. The cause of death was cardiovascular in 42.8% of cases. Freedom from MACE was 96.7%, 88.6%, and 77.3% at 1, 3, and 5 years, respectively. Cox multivariate regression analysis identified age, dialysis, left ventricular dysfunction, insulin-dependent diabetes, hematoma prolonging hospitalization, coronary artery disease, and superficial femoral plus iliac lesions as positive predictors of all-cause mortality. In the risk stratification analysis, the overall 5-year survival rate was significantly lower in high-risk patients compared to the other groups (90.1% vs. 78.6% vs. 53.5%, p<0.0001).
  
  
  CONCLUSIONS
  The prognosis in patients with intermittent claudication after endovascular therapy was relatively good but extremely poor for the high-risk patient subgroup.
authors.affiliation: 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Miura
authors.forename: Yoshimitsu
authors.initials: Y
authors.lastname: Soga
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Miyashita
authors.forename: Osamu
authors.initials: O
authors.lastname: Iida
authors.forename: Daizo
authors.initials: D
authors.lastname: Kawasaki
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hirano
authors.forename: Kenji
authors.initials: K
authors.lastname: Suzuki
authors.forename: Uichi
authors.initials: U
authors.lastname: Ikeda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D003251:Constriction, Pathologic; D018572:Disease-Free Survival; D005260:Female; D005263:Femoral Artery / Q000503:physiopathology; D006801:Humans; D007083:Iliac Artery / Q000503:physiopathology; D007383:Intermittent Claudication / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
keywords: balloon angioplasty; complications; endovascular therapy; hematoma; iliac artery; intermittent claudication; mortality; occlusion; outcome analysis; peripheral artery disease; stenosis; stent; superficial femoral artery