eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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2/2019
vol. 15
 
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abstract:
Original paper

Predictors of mortality and outcomes after retrograde endovascular angioplasty in patients with peripheral artery disease

Pawel Kleczynski
1
,
Zoltan Ruzsa
2, 3
,
Joanna Wojtasik-Bakalarz
1
,
Andras Nyerges
2
,
Artur Dziewierz
1
,
Rafał Januszek
4
,
Tomasz Rakowski
1
,
Dariusz Dudek
1
,
Stanislaw Bartus
1

  1. 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
  2. Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
  3. Invasive Cardiology Department, Bács-Kiskun County Hospital, Teaching Hospital of the Szent-Györgyi Albert Medical University, Kecskemét, Hungary
  4. Department of Clinical Rehabilitation, University of Physical Education, Krakow, Poland
Adv Interv Cardiol 2019; 15, 2 (56): 234–239
DOI: https://doi.org/10.5114/aic.2019.81727
Online publish date: 2019/01/30
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Introduction
Endovascular revascularization (ER) techniques in patients with peripheral artery disease (PAD) have been developed and became more accessible in recent years. The ER is a first-line treatment in the majority of patients with symptomatic PAD. However, data on assessment of predictors of long-term outcomes of retrograde ER in patients with PAD are scarce.

Aim
To evaluate predictors of long-term outcomes of retrograde ER in patients with chronic total occlusion in lower limb arteries.

Material and methods
We analyzed data of 834 patients who underwent retrograde ER. Baseline clinical characteristics and procedural data were collected. Patients were followed up for 36 months, and the primary endpoint was all-cause mortality.

Results
All patients were symptomatic and had failed antegrade ER. The procedural success rate was 92%. Cumulative all-cause mortality was 13.4% at 36-month follow-up. In multivariate analysis history of stroke, Rutherford category, chronic limb ischemia, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD) and previous ER of other lesion were independent predictors of a higher mortality rate after 36 months (hazard ratio (HR) for stroke 2.4, 95% confidence interval (CI): 1.55–3.66; p = 0.0002; HR for age per 10 years 1.37, 95% CI: 1.15–1.64; p = 0.0002; HR for Rutherford category 1.63, 95% CI: 1.35–1.98; p < 0.0001, HR for chronic limb ischemia 0.44, 95% CI: 0.25–0.8, p = 0.007; HR for CKD 1.73, 95% CI: 1.14–2.56, p = 0.01; HR for COPD 2.4, 95% CI: 1.5–3.7, p = 0.0004; HR for previous ER 0.59, 95% CI: 0.35–0.94, p = 0.02).

Conclusions
History of stroke, Rutherford category, chronic limb ischemia, CKD, COPD, and previous ER of other lesion were independently associated with increased risk of all-cause death.

keywords:

peripheral artery disease, endovascular revascularization, retrograde, mortality, outcomes
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