Staged endovascular repair of critical limb ischemia in high risk patients: the procedural and clinical outcomes.

Background: The aim of this paper was to retrospectively evaluate the procedural and clinical outcomes after staged angioplasty in high-risk, chronic, critical limb ischemia (CLI) patients.

Methods: Between 2013 and 2015, 29 patients (29 limbs) (mean age 77 years) were treated by staged revascularization procedures in 1) the iliac artery-DFA alone or with the femoropopliteal artery followed by 2) the femoropopliteal artery and a below-the-knee artery. All patients had long-segment iliofemoral artery and below-the-knee artery (TASCII D) occlusions with abnormal serum myoglobin and ischemic lesions. Clinical outcome was assessed at 1, 3, 6, and 12 months. Clinical treatment efficacy was defined as patient survival with resolved CLI without major amputations after the last revascularization procedure.

Results: Angioplasty was performed in all limbs with a technical success rate of 100%. All the patients received 2 stage endovascular interventions. The interval time between the two stages was 19.56±6.56 days. In the second stage, the peroneal artery (PA) in 11 patients, the anterior tibial artery (ATA) in 7 patients, both the PA and ATA in 6 patients, and the posterior tibial artery (PTA) in 6 patients were recanalized. Rest pain and lesions were resolved in all patients after the second-stage revascularization. An upward shift of limb status and EQ-5D scores after the first or second revascularization indicated a significant change. No major amputations occurred, although minor amputations were required in 5 patients within 3 months after the second endovascular revascularization. The primary patency was 82.76%. Repeat TLR was necessary for 5 patients after endovascular BTK revascularization. Clinical treatment efficacy was 71% at 12 months; the cumulative rate of repeat target limb revascularization was 45.6%.

Conclusions: Staged endovascular treatment in high-risk CLI patients can effectively relieve rest pain and symptoms of necrosis, which greatly improves the survival and quality of life of patients less suited for conventional repair.