Log in to MyACC
Contemporary Outcomes of Endovascular Revascularization of Acute Limb Ischemia
Quick Takes
- Patients with acute limb ischemia who undergo endovascular revascularization are at high risk of in-hospital mortality and amputation.
- Patients with key risk factors or advanced presentation experience in-hospital adverse events at a higher rate than those without similar risk factors.
- Among patients with 2-3 of severe lung disease, end-stage renal disease, and Rutherford Class IIb presentation experience a >15% risk of in-hospital death or amputation.
Study Questions:
What are the contemporary outcomes and predictors of adverse events following endovascular treatment of acute limb ischemia (ALI) in a broad, nationwide, multicenter peripheral vascular registry?
Methods:
The authors examined all patients undergoing peripheral vascular intervention for the indication of ALI in the National Cardiovascular Data Registry Peripheral Vascular Intervention (NCDR PVI) registry between 2014 and 2020. The primary outcomes were all-cause mortality and major amputation during the index hospitalization.
Results:
There were 3,541 endovascular procedures in the registry during the 6-year study period. Of these, 132 (3.7%) resulted in death and 77 (2.2%) resulted in major amputation during the index hospitalization. Thrombolysis catheters were used in 27.7% of cases and thrombectomy catheters were used in 3.9% of cases. Independent predictors of death or amputation during the index hospitalization included severe lung disease (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.17-2.52), Rutherford Class IIb lesions (OR, 2.44; 95% CI, 1.62-3.65), and end-stage renal disease (OR, 3.94; 95% CI, 1.83-8.49). Among patients with 0-1 risk factor, the composite rate of death or amputation was 4.0-5.6%, while those with 2-3 risk factors experienced a composite rate of 16.2-20.0%. Other notable periprocedural complications included bleeding within 72 hours of intervention in 6.7% of cases and thrombosis in 2.8% of cases.
Conclusions:
The authors conclude that patients with pre-existing medical comorbidities and those with diminished limb vitality were most likely to suffer death or amputation following an endovascular intervention for ALI.
Perspective:
ALI is a life-threatening condition, akin to an ST-segment elevation myocardial infarction (STEMI) of the leg. While some patients present in extremis and are not eligible for any revascularization procedure, a significant proportion of patients are treated endovascularly. In this contemporary, multicenter analysis, two key findings emerge. First, in-hospital complication rates are high for patients undergoing endovascular revascularization for ALI. This does not take into account the rate of all-cause mortality and amputation for patients deemed too sick or advanced to even undergo endovascular revascularization in the first place. Second, patients with 2-3 risk factors (severe lung disease, end-stage renal disease, Rutherford Class IIb lesions) experienced extremely high rates of in-hospital adverse events (>15%).
Given these findings, it is imperative that all cardiovascular clinicians be vigilant in identifying patients with risk factors for peripheral artery disease and initiate guideline-recommended therapies aimed at reducing major adverse cardiac events and major adverse limb events, including smoking cessation, aggressive lipid therapy, and use of dual pathway antithrombotic therapy (e.g., rivaroxaban 2.5 mg twice daily and low-dose daily aspirin).
Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Aortic Surgery, Interventions and Vascular Medicine
Keywords: Amputation, Endovascular Procedures, Myocardial Revascularization, Peripheral Vascular Diseases, PVI Registry
< Back to Listings
