Endovascular Outcomes Worse With Critical Limb Ischemia vs Intermittent Claudication

By Lorraine L. Janeczko

November 29, 2021

NEW YORK (Reuters Health) - Patients who receive endovascular treatment for critical limb ischemia (CLI) have worse outcomes than those who are treated for intermittent claudication (IC), according to a new study.

"We report significant differences in anatomic, lesion level, and 1-year outcomes between patients with CLI and IC undergoing (lower extremity) endovascular revascularization for symptomatic (peripheral-artery disease)," researchers write in Circulation: Cardiovascular Interventions. "Patients with IC and CLI have significant anatomic, lesion, and treatment differences with significantly higher mortality and adverse limb outcomes in CLI."

For the study, Dr. Subhash Banerjee of the University of Texas Southwestern Medical Center, in Dallas, and colleagues examined data on patients in the Excellence in Peripheral Artery Disease registry who were treated over about 14 years at 23 hospitals in the U.S.

The mean age of the 1,983 IC patients was 66 years and that of the 1,343 CLI patients, 68 years. Patients with CLI were more likely to have chronic kidney disease and diabetes and were less likely to receive optimal medical therapy.

Those with IC were more likely to have femoropopliteal artery interventions (87% vs. 65%; P<0.001). Below-the-knee interventions were more likely in CLI (47% vs. 12%; P<0.001).

A higher percentage of patients with CLI had multilevel peripheral-artery disease (32% vs. 15%, P<0.001), while those with IC were more likely to receive stents (48% vs. 37%; P<0.001) and less likely to be treated with balloon angioplasty (25% vs. 37%; P<0.001).

Major adverse limb events occurred in 16% of IC patients and 26% of CLI patients (P<0.001); all-cause mortality was 4% among CLI patients and 2% among those with IC (P=0.014).

The authors note that, because patients were followed for only one year, many later events were not captured.

Dr. Matthew C. Bunte, a cardiologist at Saint Luke's Mid America Heart Institute in Kansas City, Missouri, who wrote an editorial accompanying the study, told Reuters Health by email, "This analysis is impactful because of its large, geographically diverse, prospective sample of patients with symptomatic PAD."

"Endovascular treatment for symptomatic (peripheral-artery disease) is safe and can be effective in improving cardiovascular health," he said. "We should not forget the importance of medical treatment in this population for long-term cardiovascular-risk reduction."

Dr. Bunte urged patients, their primary-care doctors, and their vascular specialists to "work together to understand the cardiovascular risk implicated with peripheral-artery disease. Too often, the opportunities of lifestyle modification and medical treatments known to reduce cardiovascular risk are not afforded appropriate attention."

"We need to better understand the socioeconomic, cultural, and environmental factors among the populations we treat, given the well-established care disparities with peripheral-artery disease," he advised. "Patient-level health status assessment and population-level health resource utilization remain important aspects of PAD care that deserve additional focus."

While Dr. Bunte called the high quality of the data a strength of the study, he also noted "important limitations of this analysis, including the potential for selection bias among cases reported and the lack of representation of surgical treatment for" peripheral-artery disease.

Boston Scientific Corporation helped fund the study.

Dr. Banerjee and his colleagues did not respond to requests for comment.

SOURCE: https://bit.ly/3qC2gkY and https://bit.ly/3kCcjmu Circulation: Cardiovascular Interventions, online October 27, 2021.

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