Heart failure is associated with reduced patency after endovascular intervention for symptomatic peripheral arterial disease

Meltzer, Andrew J.; Shrikhande, Gautam; Gallagher, Katherine A.; Aiello, Francesco; Kahn, S. Lowell; Connolly, Peter H.; McKinsey, James F.

doi:10.1016/j.jvs.2011.08.016

Cited by 31 publications

(20 citation statements)

References 32 publications

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“…2,3 Numerous recent reports, however, have identified a role for endovascular therapy in selected patients with limb-threatening ischemia. [4][5][6] Although the availability of these complimentary approaches may benefit patients and providers alike, identification of the optimal revascularization strategy for any given patient can be challenging. The heralded BASIL trial remains the only randomized, controlled study addressing this issue, 19 but debate surrounding the applicability of BASIL with respect to disease severity and treatment modalities highlights an inherent limitation of randomized controlled trials: however well-designed, the trial results may not be readily applicable to the individual patients encountered in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 However, numerous recent reports describe acceptable limb salvage rates with endovascular therapy in select patients. [4][5][6] Although the durability of endovascular interventions in patients with CLI is inferior to bypass surgery, a minimally invasive, endovascular approach may be preferable in patients at the highest risk for perioperative adverse events. Perioperative risk assessment is a fundamental consideration for clinical decision making in CLI, but patient suitability for surgery may be difficult to determine.…”

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confidence: 99%

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The Comprehensive Risk Assessment for Bypass (CRAB) facilitates efficient perioperative risk assessment for patients with critical limb ischemia

Meltzer

Graham

Connolly

et al. 2013

Journal of Vascular Surgery

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The CRAB is a CLI-specific, risk assessment instrument derived from multi-institutional American College of Surgeons-National Surgical Quality Improvement Program surgical outcomes data that out-performs existing prognostic risk indices in the prediction of clinically significant adverse events after bypass surgery. Use of the CRAB as a risk assessment tool provides an evidence basis for patient-centered clinical decision making and may have a role in identifying patients at higher risk for surgical revascularization in whom an endovascular approach is preferable.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

The Comprehensive Risk Assessment for Bypass (CRAB) facilitates efficient perioperative risk assessment for patients with critical limb ischemia

Meltzer

Graham

Connolly

et al. 2013

Journal of Vascular Surgery

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“…HF and LV dysfunction result in decreased patency in the chronic phase 17) , and the incidence of with PAD undergoing vascular surgery in order to decrease cardiac morbidity and mortality 4) . In the present study, the 30-day mortality rate was significantly decreased among those treated with beta-blockers, without a corresponding increase in major amputation or bypass conversion within 30 days after surgery.…”

Section: Baseline Characteristicsmentioning

confidence: 99%

Beta-blocker Treatment Does Not Worsen Critical Limb Ischemia in Patients Receiving Endovascular Therapy

Soga

Iida

Takahara

et al. 2015

JAT

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Aim: It has been reported that beta-blockers (BB) reduce cardiovascular events in patients with atherosclerotic disease. However, little is known about the efficacy of these drugs in patients with critical limb ischemia (CLI). We investigated whether beta-blocker therapy affects the clinical outcomes of CLI patients. Methods: Between March 2004 and December 2011, 1,873 consecutive CLI patients who received endovascular therapy (EVT) (394 BB-treated patients and 1,479 non-BB-treated patients) for de novo infrainguinal lesions were identified retrospectively. A propensity score analysis was used for risk adjustment in a multivariable analysis and one-to-one matching (BB: 305, non-BB 305). The primary endpoint was amputation-free survival (AFS), and the secondary endpoints were overall survival and the rates of limb salvage and freedom from major adverse limb events (MALE; including repeat reintervention, surgical conversion and major amputation). The mean follow-up period was 22 15 months. Results: In the propensity score-matched pair analysis, there were no significant differences in AFS between the patients treated with and without beta-blockers (58.8% vs. 58.5% at three years, logrank p 0.76). There were also no significant differences in the limb salvage rate (88.3% vs. 88.8 at three years, log-rank P 0.41), overall survival (63.0% vs. 62.4% at three years, log-rank P 0.70) and freedom from MALE (43.6% vs. 44.9% at three years, log-rank P 0.58) between the patients treated with and without beta-blockers. Conclusions

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“…[8][9][10][11][12][13][14][15][16] Cardiac co-morbidities are common in CLI patients, and the prevalence of HF has been reported to be 10-40% in this population. [8][9][10][11][12][13][14][15][16] Although HF has been identified as an important risk factor for increased mortality and/or amputation, most studies failed to stratify HF patients by left ventricular ejection fraction (EF) 10,12,13,17 or limited their evaluation to those with left ventricular systolic dysfunction. 11,14,15 Inadequate systemic perfusion as a consequence of HF may pose a threat to CLI patients by putting them at a higher risk for embolism.…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes in patients with critical limb ischemia and heart failure with preserved or reduced ejection fraction

et al. 2017

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The impact of heart failure (HF) on long-term survival in patients with critical limb ischemia (CLI) has not been well described. Outcomes stratified by left ventricular ejection fraction (EF) are also unknown. A single center retrospective chart review was performed for patients who underwent treatment for CLI from 2006 to 2013. Baseline demographics, procedural data and outcomes were analyzed. HF diagnosis was based on appropriate signs and symptoms as well as results of non-invasive testing. Among 381 CLI patients, 120 (31%) had a history of HF and 261 (69%) had no history of heart failure (no-HF). Within the HF group, 74 (62%) had HF with preserved ejection fraction (HFpEF) and 46 (38%) had HF with reduced ejection fraction (HFrEF). The average EF for those with no-HF, HFpEF and HFrEF were 59±13% vs 56±9% vs 30±9%, respectively. The likelihood of having concomitant coronary artery disease (CAD) was lowest in the no-HF group (43%), higher in the HFpEF group (70%) and highest in the HFrEF group (83%) ( p=0.001). Five-year survival was on average twofold higher in the no-HF group (43%) compared to both the HFpEF (19%, p=0.001) and HFrEF groups (24%, p=0.001). Long-term survival rates did not differ between the two HF groups ( p=0.50). There was no difference in 5-year freedom from major amputation or freedom from major adverse limb events between the no-HF, HFpEF and HFrEF groups, respectively. Overall, the combination of CLI and HF is associated with poor 5-year survival, independent of the degree of left ventricular systolic dysfunction.

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Heart failure is associated with reduced patency after endovascular intervention for symptomatic peripheral arterial disease

Abstract: CHF is associated with reduced patency after peripheral endovascular intervention and is an independent risk factor for patency loss. Specifically, CHF and reduced EF (<40%) is a strong independent risk factor for patency loss.

Cited by 31 publications

References 32 publications

The Comprehensive Risk Assessment for Bypass (CRAB) facilitates efficient perioperative risk assessment for patients with critical limb ischemia

The Comprehensive Risk Assessment for Bypass (CRAB) facilitates efficient perioperative risk assessment for patients with critical limb ischemia

Beta-blocker Treatment Does Not Worsen Critical Limb Ischemia in Patients Receiving Endovascular Therapy

Long-term outcomes in patients with critical limb ischemia and heart failure with preserved or reduced ejection fraction

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