Determinants of intermediate term clinical outcome after endovascular below-knee interventions

Abstract

Background: To determine predictors of clinical outcome after endovascular interventions of crural arteries in patients with peripheral arterial disease. Patients and methods: We prospectively followed 154 limbs in 147 patients treated with below the knee endovascular interventions for critical limb ischemia (52 %) and severe claudication (48 %). Patient-immanent, hemodynamic-procedural and anatomic determinants of outcome were analyzed. Outcome was defined as event-free survival from the combined endpoint freedom from re-intervention, major amputation and death. Results: Cumulative event-free survival after 12 months was 65.1 %. During follow-up 42 patients (27.3 %) required re-intervention, 8 (5.2 %) underwent major amputation and 5 (3.2 %) died. In univariate analyses, the presence of critical limb ischemia, multilevel disease, age > 72 years, impaired renal function, and long lesions (> 65 mm) were significant determinants of the study endpoint. The anatomic location of the lesion, distal patency of treated artery below the ankle, cardiovascular risk factors or concomitant cardiovascular diseases, and the type of postinterventional antithrombotic treatment did not influence outcome. Conclusions: Below-knee interventions resulted in acceptable procedural mid-term results and high rates of amputation free survival. Multilevel disease, long lesions and impaired renal function were indicative of a worse outcome.