SS21 - Progression of Peripheral Artery Disease Severity after Interventions for Intermittent Claudication

Saturday, June 22, 2024

8:33 AM - 8:44 AM CT

Location: West Building, Level 3, Skyline Ballroom W375ab

Submitting & Presenting Author(s)

Jeffrey J. Siracuse, MD, MBA

Professor of Surgery and Radiology
Boston University
Boston, Massachusetts

Co-Author(s)

Sanuja Bose, MD (she/her/hers)

Postdoctoral Research Fellow
Johns Hopkins University School of Medicine
Baltimore, Maryland
Andrea Alonso, MD

Boston, Massachusetts
Sharon C. Kiang, MD

Chief Division of Vascular Surgery, Associate Professor
Loma Linda VA Healthcare System
Loma Linda, California
JC

Jesse A. Columbo

Vascular Surgeon
Dartmouth Hitchcock Medical Center
Lebanon NH, New Hampshire
AF

Alik Farber, MD, MBA

Chief, Division of vascular and Endovascular Surgery
Boston Medical Center
WESTON, Massachusetts
James H. Black, III, MD

Professor and Chief
Johns Hopkins University School of Medicine
Baltimore, Maryland
NO

Nicholas H. Osborne, MD, MS

Assistant Professor
University of Michigan
Ann Arbor, Michigan
PG

Philip P. Goodney, MD, MS

Vascular Surgeon
Dartmouth Hitchcock Medical Center
Lebanon, New Hampshire

Senior Author(s)

Caitlin W. Hicks, MD, MS (she/her/hers)

Associate Professor of Surgery
Johns Hopkins University
Baltimore, Maryland

Objectives: Intermittent claudication (IC) rarely progresses to chronic limb-threatening ischemia (CLTI) or limb loss in its natural course. However, interventions for IC have raised concern of predisposing patients to progression of disease. Our goal was to assess for long-term conversion to CLTI, repeat interventions, and ipsilateral amputations in patients undergoing first time femoropopliteal (FP) endovascular interventions for IC.

Methods: The Vascular Quality Initiative Vascular Implant Surveillance and Interventional Outcomes Network (VQI-VISION) Medicare-linked dataset was used to assess patients with IC and FP disease who were treated with endovascular intervention. CPT and ICD-10 codes were used to assess for indication for intervention and reinterventions (both open and endovascular). Demographics, comorbidities, and procedural details were recorded. Multivariable Cox proportional hazards models were used to identify independent associations with outcomes.

Results: There were 7,741 patients (mean age 72±8.4 years, 40.3% female) with IC who were treated with FP endovascular interventions, including atherectomy (28.2%) and stents (13.5%). Procedures were performed as hospital outpatient (70.2%), hospital inpatient (23.1%), and in ambulatory center or office (8.6%). After a median of 2.7 years of follow-up, 20.1% (95% CI 19.1-21.1) of patients experienced conversion to CLTI at 3 years; 16.4% (95% CI 15.4-17.4) of patients underwent a subsequent reintervention for CLTI (1.5% open, 15.6% endovascular), 1.8% underwent an ipsilateral amputation, and 26.5% underwent a subsequent reintervention for IC (2.3% open, 24.9% endovascular). After risk adjustment, progression to a CLTI diagnosis was significantly increased for patients who were impaired ambulation (HR 1.59, 95% CI 1.38 - 1.84); had diabetes (HR 1.58, 95% CI 1.41 - 1.77), renal insufficiency (HR 1.28, 95% 1.14 - 1.43), or underwent infrapopliteal intervention as part of their PVI (HR 1.50, 95% 1.30 - 1.74). Risks of ipsilateral amputation was associated with diabetes (HR 2.36, 95% CI 1.58 - 3.51), renal insufficiency (HR 2.01, 95% 1.38, 2.91), and infrapopliteal PVI (HR 1.96, 95% 1.27 - 3.05).

Conclusions: Progression to CLTI and major amputation was common after endovascular intervention for IC, particularly among patients with diabetes, renal insufficiency, and in those treated with infrapopliteal endovascular intervention. Care should be taken before performing revascularization procedures in high risk patients with IC.