title: Contemporary outcomes with percutaneous vascular interventions for peripheral critical limb ischemia in those with and without poly-vascular disease.
abstract: Given the very ill nature of patients with critical limb ischemia (CLI), the use of percutaneous vascular interventions (PVIs) for limb salvage may or may not be efficacious; in particular, for those with polyvascular arterial disease. Herein, we reviewed large, multi-institutional outcomes of PVI in polyvascular and peripheral arterial disease (PAD) patients with CLI. An 18-hospital consortium collected prospective data on patients undergoing endovascular interventions for PAD with 6-month follow-up from January 2008 to December 2011. The patient cohort included 4459 patients with CLI; of those, 3141 patients had polyvascular (coronary artery disease, cerebrovascular disease and PAD) disease, whereas 1318 patients suffered from only PAD. All patients were elderly and with significant comorbidities. The mean ankle-brachial index (ABI) was 0.44 and was not different between those with and without polyvascular disease. Polyvascular patients had more femoropopliteal and infra-inguinal interventions and less aortoiliac interventions than PAD patients. Pre- and post-procedural cardioprotective medication use was less in the PAD patients as compared with polyvascular patients. Vascular complications requiring surgery were higher in PAD patients whereas other access complications were similar between groups. At 6-month follow-up, death was more common in the polyvascular group (6.7% vs 4.1%, p<0.001) as was repeat PVI, but no difference was found in the amputation rate. Considering the group as a whole at the 6-month follow-up, predictors of amputation/death included age (HR=1.01; 95% CI=1.002-1.02), anemia (HR=2.6; 95% CI=2.1-3.2), diabetes mellitus (HR=1.6; 95% CI=1.3-1.9), congestive heart failure (HR=1.6; 95% CI=1.4-1.9), and end-stage renal failure (HR=1.9; 95% CI=1.5-2.3), while female sex was protective (HR=0.7; 95% CI=0.6-0.8). In conclusion, from examination of this large, multicenter, multi-specialist practice registry, patients with polyvascular disease had higher 6-month mortality than PAD patients, but this was not a factor in 6-month limb amputation outcomes. This study also underscores that PAD patients still lag in cardioprotective medication use as compared with polyvascular patients.
authors.affiliation: Department of Surgery, University of Michigan, USA.
authors.forename: Venkat
authors.initials: V
authors.lastname: Krishnamurthy
authors.affiliation: Department of Medicine, University of Michigan, USA.
authors.forename: Kahn
authors.initials: K
authors.lastname: Munir
authors.affiliation: Department of Surgery, University of Michigan, USA.
authors.forename: John E
authors.initials: JE
authors.lastname: Rectenwald
authors.affiliation: Spectrum Grand Rapids, Michigan, USA.
authors.forename: Ash
authors.initials: A
authors.lastname: Mansour
authors.affiliation: Providence Hospital, Michigan, USA.
authors.forename: Sachinder
authors.initials: S
authors.lastname: Hans
authors.affiliation: Department of Surgery, University of Michigan, USA.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Eliason
authors.affiliation: Department of Surgery, University of Michigan, USA.
authors.forename: Guillermo A
authors.initials: GA
authors.lastname: Escobar
authors.affiliation: Department of Surgery, University of Michigan, USA.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Gallagher
authors.affiliation: Department of Medicine, University of Michigan, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Grossman
authors.affiliation: Department of Medicine, University of Michigan, USA.
authors.forename: Hitinder S
authors.initials: HS
authors.lastname: Gurm
authors.affiliation: Department of Medicine, University of Michigan, USA.
authors.forename: Dave A
authors.initials: DA
authors.lastname: Share
authors.affiliation: Department of Surgery, University of Michigan, USA henke@umich.edu.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Henke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D055109:Ankle Brachial Index / Q000379:methods; D005121:Extremities / Q000098:blood supply*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000628:therapy*; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000628:therapy*; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology
keywords: lower extremity; peripheral vascular diseases; stents