title: Do thrombotic events during endovascular interventions lead to poorer outcomes in patients with severe limb ischemia?
abstract: BACKGROUND
  Intra-procedural acute thrombosis (IPAT) is a complication of endovascular procedures. We aim to identify risk factors for IPAT and compare the outcomes of patients with or without IPAT.
  
  
  METHODS
  Paired T test and χ (2) test were used to identify risk factors and short-term outcomes. Kaplan-Meier survival analysis was used for mid-term outcomes.
  
  
  RESULTS
  A total of 228 procedures were performed with 21 IPAT events (9.21%). The odds ratio of Indian patients developing IPAT was 2.8x (95% CI 1.1-7.6). Patients with in-stent occlusion or prior IPAT were 5.6x (95% CI 1.3-24.2) and 5.6x (95% CI 1.3-24.4) more likely to develop an IPAT event. Patients without IPAT had significantly more improvement in mean runoff score (-1.15 ± 1.31, p < 0.01). The odds of patients with IPAT requiring subsequent endovascular intervention and arterial bypass surgery were 4.2x (95% CI 1.6-10.7) and 7.1x (95% CI 1.9-27.0). There was no significant Kaplan-Meier estimated overall survival or amputation-free survival difference between patients with or without IPAT event.
  
  
  CONCLUSIONS
  Indian ethnicity, in-stent occlusion and previous IPAT were associated with higher risk of IPAT. Even after successful endovascular salvage, patients with IPATs were more likely to require secondary revascularization procedure. Patients with IPATs had no decrease in overall survival or amputation-free survival.
authors.affiliation: Ministry of Health Holdings, Singapore.
authors.forename: Daryl
authors.initials: D
authors.lastname: Chia
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, National University Health System, Singapore.
authors.forename: Kyin Kyin
authors.initials: KK
authors.lastname: May
authors.affiliation: Department of Surgery, National University of Singapore, Singapore.
authors.forename: Min Htet
authors.initials: MH
authors.lastname: Zaw
authors.affiliation: Department of Surgery, National University of Singapore, Singapore.
authors.forename: Mikael
authors.initials: M
authors.lastname: Hartman
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, National University Health System, Singapore.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Robless
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, National University Health System, Singapore surhp@nus.edu.sg.
authors.forename: Pei
authors.initials: P
authors.lastname: Ho
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000009:adverse effects*; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D023821:Limb Salvage / Q000009:adverse effects*; D035002:Lower Extremity / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D013927:Thrombosis / Q000209:etiology*; D016896:Treatment Outcome
keywords: Acute thrombosis; distal embolization; endovascular intervention; peripheral vascular disease