Do thrombotic events during endovascular interventions lead to poorer outcomes in patients with severe limb ischemia?

INTRODUCTION: Intra-procedural acute thrombosis (IPAT) is a complication of endovascular procedures. We aim to identify risk factors for IPAT and compare the outcomes of patients with or without IPAT. METHODS: Paired T test and χ (2) test were used to identify risk factors and short-term outcomes. Kaplan-Meier survival analysis was used for mid-term outcomes. RESULTS: A total of 228 procedures were performed with 21 IPAT events (9.21%). The odds ratio of Indian patients developing IPAT was 2.8x (95% CI 1.1-7.6). Patients with in-stent occlusion or prior IPAT were 5.6x (95% CI 1.3-24.2) and 5.6x (95% CI 1.3-24.4) more likely to develop an IPAT event. Patients without IPAT had significantly more improvement in mean runoff score (-1.15 ± 1.31, p < 0.01). The odds of patients with IPAT requiring subsequent endovascular intervention and arterial bypass surgery were 4.2x (95% CI 1.6-10.7) and 7.1x (95% CI 1.9-27.0). There was no significant Kaplan-Meier estimated overall survival or amputation-free survival difference between patients with or without IPAT event. CONCLUSION: Indian ethnicity, in-stent occlusion and previous IPAT were associated with higher risk of IPAT. Even after successful endovascular salvage, patients with IPATs were more likely to require secondary revascularization procedure. Patients with IPATs had no decrease in overall survival or amputation-free survival.

Limb salvage in patients with peripheral arterial disease managed by endovascular first approach.

This study aims to review the outcome of patients with peripheral arterial disease (PAD) managed with endovascular first approach for revascularization in a tertiary referral center. Revascularization procedures were performed in 202 patients with 229 symptomatic limbs. Angiogram was performed in all patients except those contraindicated for contrast agent. Angioplasty revascularization was carried out on the same setting whenever feasible based on the angiogram findings. Bypass surgery was performed in patients with arterial condition not feasible for endovascular intervention or in those with unsatisfactory revascularization after endovascular treatment. Endovascular intervention was successfully performed in 198 limbs. Bypass surgery was required in 31 patients. Another 16 patients required a bypass after endovascular intervention due to unsatisfactory wound healing. The Kaplan-Meier estimated survival and amputation-free survival were 80% and 75.5% at 1 year and 73% and 57.6% at 2 years, respectively. Satisfactory limb salvage rate can be achieved in patients with PAD managed with endovascular first approach.