Five-Year Prognosis After Endovascular Therapy in Claudicant Patients With Iliofemoral Artery Disease. (June 2014)

• Record Type: Journal Article
• Authors: Miura, Takashi; Soga, Yoshimitsu; Miyashita, Yusuke; Iida, Osamu; Kawasaki, Daizo; Hirano, Keisuke; Suzuki, Kenji; Ikeda, Uichi
• Is Part Of: Journal of endovascular therapy. Volume 21:Number 3(2014)
• Page Start: 381
• Page End: 388
• Publication Date: 2014-06
• Subjects: peripheral artery disease -- intermittent claudication -- outcome analysis -- endovascular therapy -- complications -- mortality -- hematoma -- iliac artery -- superficial femoral artery -- stenosis -- occlusion -- stent -- balloon angioplasty; Blood-vessels -- Endoscopic surgery -- Periodicals; Angioscopy -- Periodicals; Intravenous catheterization -- Periodicals; Peripheral vascular diseases -- Treatment -- Periodicals; Vascular Surgical Procedures -- Periodicals; Angioscopy -- Periodicals; Catheterization, Peripheral -- Periodicals; Peripheral Vascular Diseases -- therapy -- Periodicals; Angioscopie; Maladies vasculaires périphériques; 617.413
• DOI: 10.1583/13-4618R.1
• Languages: English
• ISSNs: 1526-6028

Abstract

Purpose: To examine the prognosis of patients with intermittent claudication who received treatment with endovascular techniques. Methods: A retrospective multicenter study was performed involving 2930 consecutive patients (2307 men; mean age 71.5±8.9 years) with intermittent claudication who underwent an endovascular procedure for a de novo iliofemoral artery lesion. The primary outcome measure was overall survival. The secondary outcomes were freedom from major adverse cardiovascular events (MACE: all-cause death, myocardial infarction, and stroke) and from major adverse cardiovascular and limb events (MACE with repeat revascularization or above-knee amputation of the target limb). Cox multivariate regression analysis of selected baseline characteristics, procedure-related complications, and medication use was performed to determine predictors for all-cause mortality. Positive predictors from this analysis were used to stratify patients into low- (1410, 48.1%), moderate- (1406, 48.0%), and high-risk (114, 3.9%) categories. Results: The overall survival rates were 97.2%, 90.8%, and 83.4% at 1, 3, and 5 years, respectively. The cause of death was cardiovascular in 42.8% of cases. Freedom from MACE was 96.7%, 88.6%, and 77.3% at 1, 3, and 5 years, respectively. Cox multivariate regression analysis identified age, dialysis, left ventricular dysfunction, insulin-dependent diabetes, hematoma prolonging hospitalization, coronary artery disease, and superficial femoral plus iliac lesions as positive predictors of all-cause mortality. In the risk stratification analysis, the overall 5-year survival rate was significantly lower in high-risk patients compared to the other groups (90.1% vs. 78.6% vs. 53.5%, p<0.0001). Conclusion: The prognosis in patients with intermittent claudication after endovascular therapy was relatively good but extremely poor for the high-risk patient subgroup.