Body mass index and long-term outcomes in patients with chronic total occlusions undergoing retrograde endovascular revascularization of the infra-inguinal lower limb arteries.

BACKGROUND: The aim of the present study is to assess the relationship between body mass index (BMI) and long-term clinical outcomes in retrograde endovascular recanalization (ER) regarding chronic total occlusions (CTOs) of the infra-inguinal lower limb arteries. METHODS: The study included patients who underwent retrograde ER of CTOs localized in superficial, popliteal or below-the-knee arteries. During follow-up, major adverse cardiac and cerebrovascular and major adverse lower limb events (MALE) were evaluated. MALE was defined as amputation, target lesion re-intervention, target vessel re-intervention and surgical treatment. RESULTS: The study included 405 patients at the mean age of 67.2 ± 10.4. The authors divided the overall group of patients according to BMI into < 25 (n = 156, 38.5%) and ≥ 25 kg/m2 (n = 249, 61.5%), and then into < 30 (n = 302, 75.8%) and ≥ 30 kg/m2 (n = 103, 24.2%). During the average follow-up 1,144.9 ± 664.3 days, the mortality rate was higher in the group of patients with BMI < 25 kg/m2 (10.5% vs. 5.3%, p = 0.051), and in the group of patients with BMI < 30 kg/m2 (8.7% vs. 2.9%, p = 0.048). The comparison of Kaplan-Meier curves revealed borderline differences when assessing months to death for the BMI < 25 kg/m2 (p = 0.057) and BMI < 30 kg/m2 (p = 0.056) grouping variables. CONCLUSIONS: Obese and overweight patients undergoing CTO ER of the lower limb arteries from retrograde access are related to lower death rates during long-term follow-up.

Mortality and chronic obstructive pulmonary disease in patients treated with endovascular revascularization of the infra-inguinal lower limb arteries from retrograde access.

BACKGROUND: In this trial, our objective was to evaluate the relationship between long-term clinical outcomes in patients with peripheral arterial disease (PAD) treated with retrograde endovascular recanalization (ER) of chronic total occlusions (CTOs) regarding the infra-inguinal lower limb arteries and chronic obstructive pulmonary disease (COPD). METHODS: A total of 834 consecutive subjects were enrolled in the study. The mean age was 67.8±10.6 years (62.6% males). COPD was diagnosed in 98 patients (11.7%). The infra-inguinal location included the deep, superficial and common femoral artery, popliteal artery or below the knee arteries. During follow-up, we evaluated major adverse cardiac and cerebrovascular events (MACCE) and major adverse limb events (MALE). MACCE was considered as death, stroke/transient ischemic attack, myocardial infarction, percutaneous coronary intervention or coronary artery bypass grafting operation, while MALE regarded amputation, target lesion re-intervention, target vessel re-intervention and surgical action. RESULTS: The mean follow-up was 1,144.9±664.3 days and the interquartile range was 1,110.5 (504.5-1,734.7). Data were collected between 2006 and 2016. We noticed significant differences in death rates among the COPD and non-COPD groups. The cumulative number of events (deaths) was 12.2%, 17.3%, 18.4%, 22.4%, 23.5%, 23.5% and 23.5% in the COPD group and 6.1%, 7.5%, 10.5%, 11.3%, 11.4% 11.5% and 11.5% in the non-COPD group after 1, 2, 3, 4, 5, 6 and 7 years of follow-up, and was notably greater for COPD (P=0.0007). CONCLUSIONS: Patients with COPD and PAD treated with the ER and retrograde approach due to CTOs are related to higher mortality than non-COPD patients.

Gender differences and long-term clinical outcomes in patients with chronic total occlusions of infrainguinal lower limb arteries treated from retrograde access with peripheral vascular interventions.

PURPOSE: We sought to investigate gender-related differences in clinical outcomes after peripheral vascular interventions (PVIs) from retrograde access in patients with chronic total occlusions (CTOs) of the infrainguinal arteries. PATIENTS AND METHODS: A total of 939 consecutive patients undergoing PVI were enrolled in the study. Patients with peripheral artery diseases (PAD) and CTOs were treated with PVI from retrograde access according to the local protocol. The participants were divided according to gender. Retrograde access included distal puncturing to reach the CTO. The mean follow-up lasted 1,144.9 ± 664.3 days. Baseline characteristics, procedural and long-term outcomes were compared according to gender. RESULTS: Women represented 37.4% of the study population, and more frequently suffered from hypertension (92% vs. 86%, p = 0.001) and diabetes (54% vs. 46%, p = 0.02). Males more often presented with chronic obstructive pulmonary disease (14.8% vs. 6.8%, p = 0.0003), coronary artery disease (45.4% vs. 32.7%, p = 0.0001), smoking (60.4% vs. 45%, p = 0.007) and prior PVI (25% vs. 17%, p = 0.005). The Kaplan-Meier survival curves at 5 years did not reveal gender-related differences in mortality (p = 0.8), whereas men were at a significantly higher risk of re-PVI during the follow-up period (p = 0.047). Male gender was an independent predictor of re-PVI (Hazard ratio: 1.276; 95% confidence interval: 1.015-1.614, p = 0.03). CONCLUSION: Males are at increased risk of re-PVI compared to females with PAD and CTOs of infrainguinal arteries treated with PVI from retrograde access.

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

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.

Combined Transradial and Transpedal Approach for Femoral Artery Interventions.

OBJECTIVES: The purpose of this prospective study was to evaluate the acute success and complication rates of combined transradial and transpedal access for femoral artery intervention. BACKGROUND: Improved equipment and techniques have resulted in transition from transfemoral to transradial access for intervention of superficial femoral artery. METHODS: Between 2014 and 2016, clinical and angiographic data from 145 consecutive patients with symptomatic superficial femoral stenosis, treated via primary radial access using the 6-F SheathLess Eaucath PV guiding catheter were evaluated in a pilot study. Secondary access was achieved through the pedal or popliteal artery. The primary endpoints were major adverse events, target lesion revascularization, and rates of major and minor access-site complications. Secondary endpoints included angiographic outcome, procedural factors, crossover rate to femoral access site, and duration of hospitalization. RESULTS: Technical success was achieved in 138 patients (95.2%). Combined radial and pedal access was obtained in 22 patients (15.1%). The crossover rate to a femoral access site was 2%. Stent implantation was necessary in 23.4% of patients. Chronic total occlusion recanalization was performed in 63 patients, with a 90.4% technical success rate. The mean contrast consumption, radiation dose, and procedure time were 112.9 ml (101.8 to 123.9 ml), 21.84 Gy/cm2 (9.95 to 33.72 Gy/cm2), and 34.9 min (31.02 to 38.77 min), respectively. The cumulative rate of access-site complications was 4.8% (0% major, 4.8% minor). The cumulative incidence rates of major adverse events at 3 and 12 months follow-up was 8.3% and 19.2%. The cumulative incidence rates of death at 3- and 12-month follow-up were 2.8% and 5.6%. CONCLUSIONS: Femoral artery intervention can be safely and effectively performed using radial and pedal access with acceptable morbidity and a high technical success rate.

Long-Term Follow-up After Retrograde Recanalization of Superficial Femoral Artery Chronic Total Occlusion.

OBJECTIVES: The aim of this study was to assess the safety of the retrograde procedure with long-term follow-up of 86 patients after retrograde recanalization of the superficial femoral artery (SFA). BACKGROUND: Chronic total occlusion (CTO) of SFAs occurs in >50% of the patient population with peripheral artery disease. The retrograde technique is an option for patients with unsuccessful antegrade percutaneous interventions, but data from long-term follow-up after retrograde recanalization are still limited. METHODS: The study included 86 patients (67% males), who underwent percutaneous retrograde recanalization. Major adverse cardiovascular or cerebrovascular events and major adverse peripheral events were assessed from long-term (47.5 ± 40 months) follow-up data. RESULTS: Mean patient age was 64 ± 9 years. Retrograde puncture was successful in all cases. Procedural success rate was 93%. In-hospital observation showed vascular perforation/bleeding in 4.7%, proximal hematoma in 9.3%, distal hematoma in 4.7%, pseudoaneurysm in 1.2%, thrombosis in 1.2%, puncture-site bleeding in 3.5%, and local inflammation in 1.2%. Mortality rate was 6.98%. Target-vessel reintervention was needed in 20.9% of cases, and percutaneous transluminal angioplasty of another artery was done in 27% of cases. Amputation rate was 4.7%. CONCLUSIONS: Long-term follow-up shows that retrograde recanalization is connected with a high rate of technical success and low percentage of reinterventions. Retrograde technique is safe and related to low complication rates; most complications were localized in nature.