Adjunct medical therapy and its impact on survival and reintervention rates in patients with common femoral artery disease undergoing endovascular revascularization or open repair.

Background

Optimal pharmacotherapy is a cornerstone for the treatment of patients with symptomatic peripheral artery disease (PAD). Our aim was to evaluate the impact of adjunct medical therapy, including lipid-lowering and antiplatelet treatment in patients undergoing open or endovascular revascularization due to common femoral artery occlusive disease (CFAOD). Patients and methods: Consecutive patients undergoing either endovascular or open revascularization due to CFAOD were analyzed. Pharmacotherapy before and after treatment was registered and its impact on the following post-procedural outcomes: (i) all-cause mortality and (ii) major adverse limb events (MALE), including major amputation and clinically driven target lesion revascularization (CD-TLR), were systematically analyzed.

Results

Patients undergoing endovascular therapy (n=225) were older and exhibited more comorbidities such as diabetes mellitus and heart failure and had more frequently chronic limb threatening ischemia (CLTI) compared to those undergoing open repair (n=662). During 1.73 (0.9-3.3) years of follow-up, 96 (10.8%) deaths and 118 (13.3%) MALE occurred. After endovascular therapy, more patients received clopidogrel (70.2% versus 41.5%) and statins (92.0% versus 74.9%), (p<.001 for both). By multivariable analysis, statin prescription was associated with lower death rates (Odds Ratio (OR)= 0.43, 95%CI=0.25-0.73, p<.002), whereas clopidogrel was associated with lower MALE rates (OR=0.65, 95%CI=0.43-0.97, p=.04). These effects were primarily driven by patients undergoing open repair (effect of statins) and by patients with chronic limb threatening ischemia (effect of clopidogrel).

Conclusions

Statin and clopidogrel treatment are important components of the post-procedural treatment of patients with PAD undergoing revascularisation due to CFAOD. Especially statins need to be prescribed based on current national and international guidelines independent of the revascularization type in every patient to reduce death rates.