Indications and Treatment Outcomes of Below-the-Knee Peripheral Artery Interventions in the XLPAD Registry

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology Pub Date : 2025-05-15 DOI:10.1016/j.amjcard.2025.05.011

Zachary P. Rosol MD , Sameh Sayfo MD , David Fernandez-Vazquez MD , Minseob Jeong MD , Mufaddal Mamawala MBBS, MPH , Anand Gupta MBBS, MPH , Blake M. Bruneman BS , Sarah G. Weideman BS , Kennedy S. Adelman BS , Shirling Tsai MD , Aravinda Nanjundappa MD , Hung B. Chu MD, RPVI , Bertram L. Smith MD , Bradley R. Grimsley MD , Stephen E. Hohmann MD , Javier Vasquez Jr MD , Chris Metzger MD , Christopher L. Henry MD , Mujtaba M. Ali MD , Timothy A. Mixon MD , Subhash Banerjee MD

{"title":"Indications and Treatment Outcomes of Below-the-Knee Peripheral Artery Interventions in the XLPAD Registry","authors":"Zachary P. Rosol MD , Sameh Sayfo MD , David Fernandez-Vazquez MD , Minseob Jeong MD , Mufaddal Mamawala MBBS, MPH , Anand Gupta MBBS, MPH , Blake M. Bruneman BS , Sarah G. Weideman BS , Kennedy S. Adelman BS , Shirling Tsai MD , Aravinda Nanjundappa MD , Hung B. Chu MD, RPVI , Bertram L. Smith MD , Bradley R. Grimsley MD , Stephen E. Hohmann MD , Javier Vasquez Jr MD , Chris Metzger MD , Christopher L. Henry MD , Mujtaba M. Ali MD , Timothy A. Mixon MD , Subhash Banerjee MD","doi":"10.1016/j.amjcard.2025.05.011","DOIUrl":null,"url":null,"abstract":"<div><div>There are unresolved questions regarding indications and outcomes of endovascular below-the-knee (BTK) interventions in patients with symptomatic peripheral artery disease (PAD) in real-world clinical practice. We analyzed 884 patients from the multicenter XLPAD registry between 2006 and 2023 with nonstent BTK PAD interventions. Primary outcome: freedom from major adverse limb events (MALE) at 1 year, a composite of all-cause death, major amputation, or clinically driven revascularization. Majority (62.8%) of the BTK interventions were performed for chronic limb threatening ischemia (CLTI), while remaining (37.2%) in patients with intermittent claudication (IC), performed together with an inflow femoropopliteal artery intervention in 58% or involving complex lesion crossings (11.8%). Nearly, 74% were men, mean age 68.0 ± 10.7 years. Mean Rutherford class was 4.65 in CLTI and 2.71 in IC groups. Moderate to severe calcification was present in 25% of cases. Significantly greater number of lesions were treated in the CLTI group (1.84 ± 1.52 vs 2.08 ± 1.61; p = 0.029). Lesion lengths (CLTI: 129.3 ± 85.1 mm vs IC: 115.5 ± 82.5; p = 0.075) were comparable. Nearly, 92% of lesions were treated with balloon angioplasty. Drug-coated balloon use was higher in IC (5% vs 15%, p <0.001), whereas atherectomy use was high in both groups (CLTI: 45.4% vs IC: 49.9%; p = 0.201). Procedural success was similar (CLTI: 92% vs IC: 88.8%; p = 0.098), however 1-year MALE was significantly higher in CLTI patients (30.5% vs 15.8% vs; p <0.0.001), driven by higher all-cause mortality (5.6% vs 2.1% vs; p = 0.014) and major amputations (14% vs 3.7%; p <0.001). Endovascular treatment for BTK PAD is more often performed in patients with CLTI compared with IC, where it is often combined with an inflow artery intervention or complex lesion crossings. Despite similar procedural success, 1-year MALE is significantly higher in CLTI, driven mainly by over a 2-fold increase in all-cause mortality and major amputations.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"251 ","pages":"Pages 38-45"},"PeriodicalIF":2.3000,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Cardiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S000291492500311X","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

There are unresolved questions regarding indications and outcomes of endovascular below-the-knee (BTK) interventions in patients with symptomatic peripheral artery disease (PAD) in real-world clinical practice. We analyzed 884 patients from the multicenter XLPAD registry between 2006 and 2023 with nonstent BTK PAD interventions. Primary outcome: freedom from major adverse limb events (MALE) at 1 year, a composite of all-cause death, major amputation, or clinically driven revascularization. Majority (62.8%) of the BTK interventions were performed for chronic limb threatening ischemia (CLTI), while remaining (37.2%) in patients with intermittent claudication (IC), performed together with an inflow femoropopliteal artery intervention in 58% or involving complex lesion crossings (11.8%). Nearly, 74% were men, mean age 68.0 ± 10.7 years. Mean Rutherford class was 4.65 in CLTI and 2.71 in IC groups. Moderate to severe calcification was present in 25% of cases. Significantly greater number of lesions were treated in the CLTI group (1.84 ± 1.52 vs 2.08 ± 1.61; p = 0.029). Lesion lengths (CLTI: 129.3 ± 85.1 mm vs IC: 115.5 ± 82.5; p = 0.075) were comparable. Nearly, 92% of lesions were treated with balloon angioplasty. Drug-coated balloon use was higher in IC (5% vs 15%, p <0.001), whereas atherectomy use was high in both groups (CLTI: 45.4% vs IC: 49.9%; p = 0.201). Procedural success was similar (CLTI: 92% vs IC: 88.8%; p = 0.098), however 1-year MALE was significantly higher in CLTI patients (30.5% vs 15.8% vs; p <0.0.001), driven by higher all-cause mortality (5.6% vs 2.1% vs; p = 0.014) and major amputations (14% vs 3.7%; p <0.001). Endovascular treatment for BTK PAD is more often performed in patients with CLTI compared with IC, where it is often combined with an inflow artery intervention or complex lesion crossings. Despite similar procedural success, 1-year MALE is significantly higher in CLTI, driven mainly by over a 2-fold increase in all-cause mortality and major amputations.

查看原文本刊更多论文

膝关节以下外周动脉介入治疗的适应症和治疗结果。

背景：在现实世界的临床实践中，关于对症状性外周动脉疾病（PAD）患者进行膝下血管内（BTK）干预的适应症和结果仍存在未解决的问题。方法：我们分析了2006-2023年间多中心XLPAD注册的884例非支架BTK PAD干预患者。主要结局：1年内无重大肢体不良事件（MALE），包括全因死亡、重大截肢或临床驱动的血运重建术。结果：大多数（62.8%）BTK干预用于慢性肢体威胁缺血（CLTI），其余（37.2%）用于间歇性跛行（IC）患者，其中58%与股腘动脉流入干预一起进行，或涉及复杂病变交叉（11.8%）。男性占74%，平均年龄68.0±10.7岁。CLTI组平均Rutherford分级为4.65，IC组平均Rutherford分级为2.71。25%的病例出现中度至重度钙化。CLTI组治疗的病灶数量明显多于CLTI组(1.84±1.52 vs 2.08±1.61；p = 0.029)。病变长度(CLTI: 129.3±85.1 mm vs. IC: 115.5±82.5 mm；P =0.075)具有可比性。近92%的病变采用球囊血管成形术治疗。结论：血管内治疗BTK PAD在CLTI患者中比在IC患者中更常见，后者通常与流入动脉介入或复杂病变交叉相结合。尽管手术上取得了类似的成功，但CLTI患者的1年男性死亡率明显更高，主要原因是全因死亡率和主要截肢增加了两倍以上。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

American Journal of Cardiology 医学-心血管系统

CiteScore

4.00

自引率

3.60%

发文量

698

审稿时长

33 days

期刊介绍： Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.