Characteristics and clinical outcomes of repeat endovascular therapy after infrapopliteal balloon angioplasty in patients with critical limb ischemia.

ObjectivesWe clarified characteristics and clinical outcomes of critical limb ischemia (CLI) patients who underwent repeat endovascular therapy (EVT) for infrapopliteal lesions. BackgroundHigh restenosis rate after infrapopliteal EVT remains a major concern. MethodsPatients with CLI who underwent EVT between April 2007 and February 2014, were divided into the following three groups according to how often EVT was repeated: Group A, no repeat of EVT; Group B, EVT repeated once/twice; and Group C, EVT repeated 3 times. ResultsWound healing rates at 1 year were 93.9% in Group A, 77.1% in Group B, and 27.3% in Group C (P<0.001). Limb salvage rates at 3 years were 93.0, 88.5, and 57.1%, respectively (P=0.001). Amputation-free survival rates at 3 years were 60.8, 51.2, and 29.2%, respectively (P=0.019). Multivariate analysis revealed that hemodialysis (OR 3.413, 95% CI 1.263-9.225, P=0.016), low ejection fraction (OR 7.758, 1.049-57.360, P=0.045), and clinical stage assessed by SVS WIfI (OR 2.440, 1.417-4.203, P=0.001) were independent predictors of repeat EVT. The rate of requirement for repeat EVT significantly increased as clinical stage became more severe (repeat EVT rate: 0% in CS 1, 28.6% in CS 2, 34.0% in CS 3, and 45.7% in CS 4, P<0.001). ConclusionsThe clinical outcomes of CLI patients requiring repeat EVT three or more times were poor. The SVS WIfI clinical stage may be useful to predict the necessity of repeat EVT.