Circulation journal : official journal of the Japanese Circulation Society · 2010
Long-term clinical outcome after endovascular treatment in patients with intermittent claudication due to iliofemoral artery disease.
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Soga Yoshimitsu, Yokoi Hiroyoshi, Urakawa Tomoko, Tosaka Atsushi, Iwabuchi Masashi, Nobuyoshi Masakiyo
Аннотация
BACKGROUND: The natural history of patients with intermittent claudication (IC) has been reported, but little is known about that of claudicant patients after endovascular therapy (EVT).
METHODS AND RESULTS: A total of 271 consecutive patients (mean age, 68+/-6 years, 82% men) with IC were treated with EVT for a de novo iliofemoral lesion. Primary patency was defined as treated vessel without re-stenosis and repeat revascularization. Major adverse cardiovascular event (MACE) included death, myocardial infarction and stroke. Median follow-up interval was 11.7+/-2.9 years. During the follow-up period, 132 patients died (cardiovascular death; 66%). Major amputation was performed in 4 patients. Primary patency rate was 82%, 79%, and 78% at 5, 10 and 15 years, respectively. Freedom from all-cause death (MACE) was 73% (69%), 58% (49%), and 43% (34%) at 5, 10 and 15 years. On multivariate Cox regression, Trans-Atlantic Inter-society Consensus grade C/D, and involvement of femoropopliteal lesion were independent predictors of primary patency. Independent predictors for overall survival were age, left ventricular dysfunction (ejection fraction <40%), coronary artery disease, diabetes, chronic kidney disease and below-the-knee disease.
CONCLUSIONS: Regardless of good clinical patency of treated vessel in patients with IC, survival was poor. Independent predictors were different between long-term patency and late mortality.
METHODS AND RESULTS: A total of 271 consecutive patients (mean age, 68+/-6 years, 82% men) with IC were treated with EVT for a de novo iliofemoral lesion. Primary patency was defined as treated vessel without re-stenosis and repeat revascularization. Major adverse cardiovascular event (MACE) included death, myocardial infarction and stroke. Median follow-up interval was 11.7+/-2.9 years. During the follow-up period, 132 patients died (cardiovascular death; 66%). Major amputation was performed in 4 patients. Primary patency rate was 82%, 79%, and 78% at 5, 10 and 15 years, respectively. Freedom from all-cause death (MACE) was 73% (69%), 58% (49%), and 43% (34%) at 5, 10 and 15 years. On multivariate Cox regression, Trans-Atlantic Inter-society Consensus grade C/D, and involvement of femoropopliteal lesion were independent predictors of primary patency. Independent predictors for overall survival were age, left ventricular dysfunction (ejection fraction <40%), coronary artery disease, diabetes, chronic kidney disease and below-the-knee disease.
CONCLUSIONS: Regardless of good clinical patency of treated vessel in patients with IC, survival was poor. Independent predictors were different between long-term patency and late mortality.