Peripheral Arterial Interventions

Two-year outcomes of patients with critical limb ischemia and long-segment infrapopliteal lesions treated with multiple everolimus-eluting coronary stents (EES) after failed angioplasty

Monday, March 22, 2021

10:00 AM – 10:09 AM ET

Presenting Author(s)

Jennifer M. Watchmaker, MD, PhD

Resident

Author/Co-author(s)

AZ

Adam Zybulewski, MD

Interventional Radiologist
rT

rami O. Tadros, MD

Associate
AV

Ageliki Vouyouka, MD

Professor
PF

Peter Faries, MD

Professor
RL

Robert Lookstein, MD MHCDL FSIR FAHA FSVM

Executive Vice Chairman

Purpose: Evaluate long-term outcomes of patients with critical limb ischemia and long-segment ( >38mm) infrapopliteal lesions treated with everolimus-eluting coronary stents (EES) with prior failed angioplasty (PTA).

Materials and Methods: We reviewed clinical and target lesion information in patients with long-segment lesions treated with EES after failed PTA between 01/2009 – 09/2018. The primary endpoint was 2-year major amputation free survival; secondary endpoints included freedom from 30-day major adverse event (MAE) and overall survival at 24-months. To evaluate the primary and secondary endpoints, Kaplan-Meier analyses was performed. The log-rank test was used to compare differences between Rutherford groups (Rutherford 4 and 5 compared to Rutherford 6) for each endpoint.

Results: Sixty-three patients (age 73.6±11.2, 24 female 39 male), with sixty-five treated limbs met inclusion criteria. Thirty-seven Rutherford 4 or 5 limbs were included, and 28 Rutherford 6 limbs were included. Mean lesion length was 102.4±53.0mm [44.0-380mm]. The mean number of stents used was 2.8; range [2-10 stents]. During the two-years post-procedure, 40 patients were censored: there were 12 deaths, 9 major amputations, and 19 patients were lost to two-year follow-up. Two-year freedom from major amputation for Rutherford 4 and 5 patients was 84.8% compared to 44.5% for patients in the Rutherford 6 group (p=0.002; Hazards Ratio: 3.9, confidence interval [1.6-9.4]). The overall amputation free survival at two-years was 66.2% and the overall two-year survival was 78.3%. There were 5 MAE within 30-days (4 deaths and 1 major amputation).

Conclusion: In patients with critical limb ischemia, placement of multiple EES in long-segment infrapopliteal lesions with prior failed PTA is a durable treatment option with two year amputation free survival of 66.6%. Patients with Rutherford 4 and 5 critical limb ischemia have markedly better outcomes compared to patients with Rutherford 6 limb ischemia.

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