Long-term follow-up after endovascular revascularisation for acute limb ischaemia - a retrospective single-centre cohort

Abstract

Summary: Background:We evaluated the long-term outcome after endovascular revascularisation for acute limb ischaemia (ALI). Patients and methods: From a prospectively maintained database, 318 endovascular interventions for ALI were identifi ed between 2004 and 2010. Event history and survival were analysed using the Kaplan-Meier method and Cox regression. Endpoints were target vessel revascularisation (TVR), non-target extremity revascularisation (NTER), amputation, major vascular events, coronary artery revascularisation and amputation-free survival. Results: Follow-up data of 303 patients (mean age 68.5 ± 12.7 years, 40 % female) were available. The mean follow-up time was 38.7 ± 26.2 months. TVR was performed in 40.1 ± 2.9 % at 1 year and 66.5 ± 3.8 % at 5 years. NTER at 1 and 5 years were 7.1 ± 1.5 % and 29.2 ± 4 %, respectively. The proportion of patients who needed major or minor amputation was 4.3 ± 1.2 % after 1 year and 9 ± 2.1 % after 5 years. Amputation-free survival at 1 year was 90.3 ± 1.8 % and 74.8 ± 3.2 % at 5 years. Coronary artery disease (HR 2.22, 95 % CI 1.33 to 3.7, p = 0.002) and atrial fi brillation (HR 2.56, % CI 1.3 to 5.04, p = 0.007) were independently associated with a worse amputation-free survival. The cumulative proportion surviving one year following acute limb ischemia was 95.4 ± 1.2 % and 79.7 ± 3.1 % after 5 years. Conclusions: Long-term amputation-free survival after successful revascularisation for ALI is high; negative predictors are coronary artery disease and atrial fi brillation.

Current Treatment Options in Acute Limb Ischemia

“…Currently, in most cases, CDT is combined with target lesion endovascular/surgical correction to improve long-term patency rates and to decrease the amputation rate [35].…”

Acute on chronic limb ischemia: From surgical embolectomy and thrombolysis to endovascular options

“…37,38 Recently, it has been proposed to combine CDT target lesion endovascular/surgical correction to guarantee an optimal treatment outcome and better long-term patency (see "hybrid treatment" section). 30,39 Ultrasound-accelerated thrombolysis…”