title: Distal embolization during lower extremity endovascular interventions.
abstract: Distal embolization (DE) during peripheral arterial endovascular interventions is a well-known complication that is poorly studied. The goal of this study was to determine the incidence, risk factors, and effect of DE on the outcomes of lower extremity endovascular interventions (LEIs).
  
  
  
  All LEIs between 2010 and 2014 in the Vascular Study Group of New England (VSGNE) database were reviewed. Patient characteristics were analyzed to determine predictors of DE. LEIs involving the superficial femoral artery (SFA) were reviewed to assess the effect of type of treatment on DE. The outcomes examined were loss of patency, limb loss, and mortality after LEI involving the SFA. A multivariable regression was used to determine predictors of DE.
  
  
  
  There were 10,875 procedures. The incidence of DE was 17.3 per 1000 procedures, and 68% required treatment (57% endovascular, 11% open surgery). DE was more common in patients treated for critical limb ischemia compared with claudication (relative risk [RR], 2.06; 95% confidence interval [CI], 1.24-3.45; P = .006) and for emergency interventions compared with elective (RR, 2.98; 95% CI, 1.22-7.30; P = .017). DE increased with the number of arteries treated (P < .0001) and with the length of occlusion (P < .0001). The SFA was the most commonly treated artery (4751 [43.7%]). In comparison with atherectomy and balloon angioplasty, stenting alone (RR, 0.36; 95% CI, 0.17-0.73; P = .005), balloon angioplasty alone (RR, 0.23; 95% CI, 0.13-0.41; P < .0001), and combined stenting and balloon angioplasty (RR, 0.29; 95% CI, 0.17-0.49; P < .0001) were associated with a significantly lower risk of DE. DE was not significantly associated with loss of patency, major amputation, or mortality.
  
  
  
  The incidence of DE during LEIs is 1% to 2% in the VSGNE database, and most patients are treated with additional endovascular interventions. The incidence increases in patients with critical limb ischemia and with the use of atherectomy.
authors.affiliation: Section of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn. Electronic address: cassius.chaar@yale.edu.
authors.forename: Cassius I
authors.initials: CI
authors.lastname: Ochoa Chaar
authors.affiliation: Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Conn.
authors.forename: Fatma
authors.initials: F
authors.lastname: Shebl
authors.affiliation: Section of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn.
authors.forename: Bauer
authors.initials: B
authors.lastname: Sumpio
authors.affiliation: Section of Vascular Surgery, Department of Surgery, West Haven Veterans Affairs, West Haven, Conn.
authors.forename: Alan
authors.initials: A
authors.lastname: Dardik
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Connecticut, Storrs, Conn.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Indes
authors.affiliation: Section of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn.
authors.forename: Timur
authors.initials: T
authors.lastname: Sarac
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D000800:Angioplasty, Balloon / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D017073:Atherectomy / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D016638:Critical Illness; D016208:Databases, Factual; D018572:Disease-Free Survival; D004617:Embolism / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D005263:Femoral Artery / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D007383:Intermittent Claudication / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D007511:Ischemia / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009511:New England / Q000453:epidemiology; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency