Risk factors of incident acute limb ischemia after contemporary femoropopliteal endovascular revascularization from a multicenter registry: A retrospective observational study.

Purpose: To investigate the incidence of acute limb ischemia (ALI) among patients with femoropopliteal (FP) lesions treated with contemporary endovascular therapy (EVT) and to identify risk factors for ALI after FP-EVT.

Methods: In this retrospective multicenter registry, we analyzed patients with lower extremity artery disease having FP lesions who underwent EVT between 2017 and 2021. We investigated the incident ALI related to the index EVT and its risk factors. We also assessed the prognosis after the incident ALI.

Results: During a median follow-up of 35.3 months, incident ALI was observed in 72 of 3102 patients (2.3%). The Rutherford classification I/IIa/IIb/III was 50.0%, 30.5%, 18.1%, and 1.4%, respectively. Variables independently associated with the incident ALI were chronic limb-threatening ischemia (CLTI; hazard ratio, 1.83; p = 0.015), reference vessel diameter < 6 mm (2.39; p = 0.011), lesion length >25 cm (3.35; p = 0.005) with its time interaction (0.72 per 1 year; p = 0.042), P2/3 segment involvement (2.73; p < 0.001), chronic total occlusion (CTO; 3.40; p < 0.001), and in-stent restenosis/occlusion (3.21; p < 0.001). During a median follow-up of 12.8 months after the ALI event, all-cause mortality was 27.8% and the rate of major amputation was 6.9%.

Conclusions: The FP-EVT showed that the occurrence of ALI was 2.3% during a median follow-up of 35.3 months. The independent predictors of the ALI event were CLTI, small vessels, long lesions, CTO, and in-stent restenosis; however, the impact of lesion length was attenuated over time after the index EVT.