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Risk Factor Analysis and Long-Term Outcomes in Patients with Endovascular Revascularization for Intermittent Claudication or Chronic Limb-Threatening Ischaemia

  • Fung Victor
    Affiliations
    Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, South Wing, 14th Floor K Block, Queen Mary Hospital, Hong Kong
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  • Yiu Che Chan
    Correspondence
    Correspondence author : Dr. Yiu Che CHAN MB BS BSc MD FRCS(England) FRCS(General Surgery) FCSHK, Associate Professor, Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, South Wing, 14th Floor K Block, Queen Mary Hospital, Pokfulam Road, Hong Kong, Hong Kong SAR, China. Tel:+852-2255-4969 FAX:+852-2255-4967
    Affiliations
    Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, South Wing, 14th Floor K Block, Queen Mary Hospital, Hong Kong
    Search for articles by this author
  • Grace C. Cheung
    Affiliations
    Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, South Wing, 14th Floor K Block, Queen Mary Hospital, Hong Kong
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  • Stephen W. Cheng
    Affiliations
    Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, South Wing, 14th Floor K Block, Queen Mary Hospital, Hong Kong
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Published:September 23, 2022DOI:https://doi.org/10.1016/j.avsg.2022.09.038

      Abstract

      Introduction

      The aim of this study is to review long-term outcome and identify risk factors for patients with PAD with percutaneous transluminal angioplasty (PTA)/ stent as primary treatment strategy for intermittent claudication (IC) or chronic limb-threatening ischaemia (CTLI).

      Methods

      Retrospective cohort study with data collected prospectively from Clinical Data Analysis and Reporting System (CDARS), departmental database, and Clinical Management System (CMS). All patients who underwent endovascular procedures for PAD between January 2011 to December 2021 were identified. The primary outcomes are overall survival (OS) and amputation free survival (AFS). Predictive factors for OS and AFS were determined using Cox Model.

      Results

      A total number of 640 patients with PAD (IC,n=243;CTLI,n=377) underwent endovascular PTA/stenting for PAD from January 2011 to December 2020. Patients with CTLI had a significantly higher 30 days’ re-admission rate (18.8%vs6.5%,p<0.001), emergency re-operation within 30 days (3.4%vs0%,p=0.002), and death within same admission (2.7%vs0%,p=0.008) compared to IC patients. The OS and AFS rates were significantly lower in CTLI patients (p< 0.0001and p< 0.0001 respectively). On Cox multivariate analysis, CTLI was strongly predictive of all-cause mortality and amputation (HR2.33andHR14.92 respectively). In patients with CTLI, chronic kidney disease (CKD) was independent predictor of mortality and amputation (HR1.66andHR2.36 respectively). Smoking and ischaemic heart disease (IHD) were also independent predictors of mortality in this subgroup (HR2.06andHR2.43 respectively).

      Conclusion

      Although patients with IC and CLTI both manifest from atherosclerotic occlusive disease of the lower limb arteries, these patients may have different clinical outcome with significant mortality occurred in both IC and CTLI groups. In patients with IC, the risk of amputation was less than 1% at 5 years following revascularization.

      Key words

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