98 - Clinical Outcomes Following Lower Limb Angioplasty in Patients with Critical Limb Ischemia

Monday, March 31, 2025

12:10 PM – 1:10 PM CT

Location: Music City Center, Expo Poster Area

Poster Presenter(s)

Sahad Zahir (he/him/his)

Medical Student
Duke-NUS Medical School, Singapore

Author/Co-author(s)

AP

Ankur Patel, MBBS

Consultant Interventional Radiologist
Department of Vascular & Interventional Radiology, SGH, Singapore
JC

Jasmine Chua, MBBS

Consultant Interventional Radiologist
Department of Vascular & Interventional Radiology, SGH, Singapore
CS

Chandramohan Sivanathan, MBBS

Senior Consultant Interventional Radiologist
Department of Vascular & Interventional Radiology, SGH, Singapore
AG

Apoorva Gogna, MBBS

Senior Consultant Interventional Radiologist
Department of Vascular & Interventional Radiology, SGH, Singapore
FI

Farah Irani, MBBS

Senior Consultant Interventional Radiologist
Department of Vascular & Interventional Radiology, SGH, Singapore
NK

Nanda Kumar, MBBS

Senior Consultant Interventional Radiologist
Department of Vascular & Interventional Radiology, SGH, Singapore
AT

Alfred Tan, MBBS

Consultant Interventional Radiologist
Department of Vascular & Interventional Radiology, SGH, Singapore
LS

Leong Sum, MBBS

Senior Consultant Interventional Radiologist
Department of Vascular & Interventional Radiology, SGH, Singapore
ZT

Zehao Tan, MBBS

Consultant Interventional Radiologist
Department of Vascular & Interventional Radiology, SGH, Singapore
TH

Tseng Hui Heng, MBBS

Associate Consultant Interventional Radiologist
Department of Vascular & Interventional Radiology, SGH, Singapore
AT

Alexander Tan, MBBS

Consultant Interventional Radiologist
Department of Vascular & Interventional Radiology, SGH, Singapore
MW

Mark Wang, MBBS

Consultant Interventional Radiologist
Department of Vascular & Interventional Radiology, SGH, Singapore
JK

Jack Kian Chng, MBBS

Senior Consultant Vascular Surgeon
Department of Vascular Surgery, SGH, Singapore
HY

Hao Yun Yap, MBBS

Senior Consultant Vascular Surgeon
Department of Vascular Surgery, SGH, Singapore
SL

Shaun Lee, MBBS

Consultant Vascular Surgeon
Department of Vascular Surgery, SGH, Singapore
LT

Luke Tay, MBBS

Senior Consultant Vascular Surgeon
Department of Vascular Surgery, SGH, Singapore
NN

Nick Ng, MBBS

Consultant Vascular Surgeon
Department of Vascular Surgery, SGH, Singapore
TC

Tze Tec Chong, MBBS, RPVI

Senior Consultant Vascular Surgeon
Department of Vascular Surgery, SGH, Singapore
Kiang Hiong Tay, FSIR, MBBS

Professor and Head of Department of Vascular & Interventional Radiology
Singapore General Hospital, Singapore

Purpose: To review and analyze outcomes following percutaneous transluminal angioplasty (PTA) as a first-line approach to patients with critical limb ischemia (CLI), and determine the factors that influence their clinical outcomes.

Materials and Methods: This is a retrospective review of 1740 patients who underwent 3066 angioplasties on 2108 limbs for CLI between July 1, 2019 and May 15, 2024. The data was collected from the Singapore General Hospital through the Society for Vascular Surgery (SVS) Vascular Quality Initiative (VQI) registry. The mean age at procedure was 69.1 ± 10.7, with 1090 (62.6%) patients being male. The comorbidities include - 1491 (85.6%) with diabetes mellitus (DM), 1596 (91.7%%) with hypertension (HTN), 904 (52.0%) with coronary artery disease (CAD), 585 (33.6%) on dialysis, and 362 (20.8%) with cerebrovascular disease (CVD). The number of arteries treated per procedure was - 394 (12.9%) with 1 artery, 853 (27.8%) with 2 arteries, 958 (31.2%) with 3 arteries, and 861 (28.1%) with 4 arteries. The 3 most frequently treated arteries were the superficial femoral artery (SFA, 21.2%), anterior tibial artery (ATA, 20.1%), and popliteal artery (PA, 18.9%). In terms of the type of treatment, drug-coated balloon (DCB) was used in 37.4% of procedures, bare metal stent in 7.4%, drug eluting stent in 2.0%, and atherectomy in 2.7%. Limb salvage rates and overall survival rates were calculated by Kaplan-Meier method.

Results: The overall survival rates at 30-day, 6-month, and 1-year were 97.6%, 86.5% and 77.6% respectively, and limb salvage rates were 94.6%, 92.0%, and 89.3% respectively. Post-procedural complications include 0.65% with acute thrombosis, 1.4% with distal embolization, and 2.7% with puncture site hematoma. Using the outcome of mortality, univariate cox regression analysis identified the following significant predictors - dialysis use (P < 0.001), history of CAD (P < 0.001), history of dysrhythmia (P < 0.001), history of CHF (P < 0.001) , history of symptomatic CVD (P = 0.002) , age > 65 years (P < 0.001).

Conclusion: PTA as a first-line approach to the treatment of CLI is safe and effective. Dialysis use, history of CAD, CHF, symptomatic CVD, and age > 65 are predictors of poor outcomes.