Repeat intervention increases amputation risk after infrapopliteal angioplasty for CLI
The need for repeat intervention after infrapopliteal angioplasty for critical limb ischemia may increase risk for future major amputation.
Researchers searched the multicenter J-BEAT III registry — which records data on patients with CLI in Japan undergoing balloon angioplasty for de novo, isolated below-the-knee atherosclerotic lesions — to identify patients who underwent balloon angioplasty for this indication from April 2004 to December 2012. In total, the researchers identified 1,298 limbs of 1,065 patients. The mean age was 72 years and 739 were men.
During a median follow-up of 1.2 years (interquartile range, 0.4-2.5), major amputation was performed on 11% of limbs. Thirty-eight percent required repeat intervention; of those, 72 cases required bypass surgery and 427 cases required repeat angioplasty. The Kaplan-Meier estimated rate of repeat intervention and major amputation was 49.2% at 2 years, according to findings published in the Journal of Endovascular Therapy.
The researchers performed mixed-effects modeling and identified a significant association between repeat intervention and future risk for major amputation (unadjusted HR = 3.01; 95% CI, 2.05-4.41).
Repeat intervention was associated with significantly greater risk for major amputation among patients with regular dialysis (HR = 3.35; 95% CI, 2.14-5.26). However, this association was not seen in patients without regular dialysis (HR = 1.67; 95% CI, 0.71-3.93).
According to the researchers, “the risk of major amputation in dialysis patients is high when their conditions require reintervention and these repeat interventions are unlikely to reduce the future risk of amputation. Moreover, in nondialysis patients, repeat intervention may reduce the risk of amputation to levels similar to those in patients requiring endovascular therapy only once.”
In other results, repeat intervention within 1 year was also linked with a higher prevalence of tissue loss, infection, regular dialysis and nonambulatory status. The estimated incidence of major amputation at 1 year was 11.2% among patients requiring repeat intervention within 1 year.
The researchers noted that drug-coated balloons and debulking devices were not available for use in Japan when this study was conducted. “Innovative use of such devices to achieve long-term patency may prevent amputation without requiring repeat endovascular therapy,” they wrote. – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.