Infrapopliteal Endovascular Interventions for Claudication Are Associated With Poor Long-term Outcomes in Medicare-matched Registry Patients.
Academic Article
Overview
abstract
OBJECTIVE: To evaluate the association of infrapopliteal peripheral vascular intervention (PVI) with long-term outcomes compared with isolated femoropopliteal PVI for the treatment of claudication. BACKGROUND: There are limited data supporting or opposing the use of infrapopliteal PVIs for the treatment of claudication. METHODS: We conducted a retrospective analysis of all patients in the Medicare-matched Vascular Quality Initiative database who underwent an index infrainguinal PVI for claudication from January 2004 to December 2019 using Cox proportional hazards models. RESULTS: Of 14,261 patients (39.9% females; 85.6% age ≥65 years, 87.7% non-Hispanic White) who underwent an index infrainguinal PVI for claudication, 16.6% (N = 2369) received an infrapopliteal PVI. The median follow-up after index PVI was 3.7 years (interquartile range: 2.1-6.1). Compared with patients who underwent isolated femoropopliteal PVI, patients receiving any infrapopliteal PVI had a higher 3-year cumulative incidence of conversion to chronic limb-threatening ischemia (33.3% vs 23.8%; P < 0.001), repeat PVI (41.0% vs 38.2%; P < 0.01), and amputation (8.1% vs 2.8%; P < 0.001). After risk adjustment, patients undergoing infrapopliteal PVI had a higher risk of conversion to chronic limb-threatening ischemia [adjusted hazard ratio (aHR): 1.39, 95% CI: 1.25-1.53], repeat PVI (aHR: 1.10, 95% CI: 1.01-1.19), and amputation (aHR: 2.18, 95% CI: 1.77-2.67). Findings were consistent after adjusting for competing risk of death, in a 1:1 propensity-matched analysis, and in subgroup analyses stratified by TASC disease, diabetes, and end-stage kidney disease. CONCLUSIONS: Infrapopliteal PVI is associated with worse long-term outcomes than femoropopliteal PVI for claudication. These risks should be discussed with patients.
