Risk factors for progression to chronic limb-threatening ischemia after endovascular therapy in patients with claudication.

Introduction: This study aimed to evaluate the incidence and risk factors for progression to chronic limb-threatening ischemia (CLTI) in patients with peripheral artery disease (PAD) and de novo claudication who underwent endovascular therapy (EVT), particularly femoropopliteal intervention.

Methods: A total of 338 limbs from consecutive patients with de novo claudication who received their first EVT were evaluated. The primary endpoint was progression to CLTI, assessed using the Kaplan-Meier estimate and hazard ratios (HRs) calculated via Cox regression analysis.

Results: CLTI developed in 21 of 196 femoropopliteal interventions and four of 142 aortoiliac interventions. The median time from initial femoropopliteal intervention to CLTI onset was 2.4 years. Limbs treated with femoropopliteal intervention progressed to CLTI more often than those treated with aortoiliac intervention (estimated 10-year incidence: 15.3% vs 8.6%). Univariate analysis identified chronic kidney disease with or without hemodialysis (HR: 6.43; 95% CI: 2.02-24.1, HR: 3.13; 95% CI: 1.02-11.6), chronic heart failure (HR: 2.71; 95% CI: 1.14-6.55), severe calcification (HR: 2.98; 95% CI: 1.06-7.39), P2-3 segment intervention (HR: 4.72; 95% CI: 1.52-12.4), and poor infrapopliteal runoff (HR: 15.1; 95% CI: 5.06-64.7) as risk factors. Multivariate analysis showed poor infrapopliteal runoff as an independent predictor (HR: 11.2; 95% CI: 3.56-49.3).

Conclusion: Progression to CLTI following femoropopliteal intervention in patients with claudication is influenced by comorbidities, vessel calcification, involvement of the P2-3 segment, and especially poor infrapopliteal runoff, regardless of EVT strategy.