Infrapopliteal peripheral vascular interventions for claudication are performed frequently in the USA and are associated with poor long-term outcomes

Selected in ESVS Journal by Adnan Nseif

As infrapopliteal peripheral vascular interventions (PVIs) for claudication continue to be performed in the USA, this study assessed whether infrapopliteal PVI is linked to worse long-term outcomes than isolated femoropopliteal PVI.

References:

Authors: Sanuja Bosea, Chen Dunb, Alex J. Solomond, James H. Black, Michael S. Contee, Corey A. Kalbaughf, Karen Woog, Martin A. Makaryb, and Caitlin W. Hicks

Reference: European Journal of Vascular and Endovascular Surgery - Available online 19 June 2024

DOI: 10.1016/j.ejvs.2024.06.017

Read the abstract

Objectives:

To evaluate whether infrapopliteal PVI is associated with worse long-term outcomes compared with isolated femoropopliteal PVI for the treatment of claudication.

Population:

Retrospective cohort study, multicenter, including 36,147 patients with claudication. Exposure was any index infrapopliteal PVI, including both infrapopliteal PVI in isolation and infrapopliteal PVI with concomitant femoropopliteal PVI, compared with index isolated femoropopliteal PVI

Endpoints:

Conversion to CLTI, any repeat PVI, and major amputation.

Outcomes and conclusion:

Among Medicare beneficiaries in the USA who underwent an infra-inguinal PVI to treat claudication, infrapopliteal PVI was associated with worse long term outcomes compared with isolated femoropopliteal PVI.

Infrapopliteal peripheral vascular interventions for claudication

Comments:

26 % of patients treated for leg artery issues progressed to critical limb ischemia within 3 years.
Natural progression: 5-10 % of claudicants develop critical limb ischemia without any surgical treatment.
High prevalence of endovascular treatment under general anesthesia in claudicants (32 %), despite numerous recommendations cautioning against this approach.
Increased risk of major amputation in patients treated under general anesthesia. Claudicant patients with leg artery disease are at a higher risk of amputation.
Increased risk of additional lower limb amputation.
Recurrence of symptoms? Disease progression? Prophylactic amputation based on follow-up imaging?
Limitations:
- Classification bias: ICD-10 code
- The national registry includes patients over 65 years old.
- Retrospective study