Predictors of adverse clinical outcomes after successful infrapopliteal intervention

Abstract

Objectives To clarify the clinical and angiographical variables related to delayed wound healing, major amputation and death after successful infrapopliteal intervention in critical limb ischemia patients with tissue loss. Background There is an underappreciation of adverse clinical outcomes after successful infrapopliteal intervention. Methods Stent-assisted infrapopliteal angioplasty was successful in 106 limbs in 85 patients. Successful intervention was defined as revascularization of at least one straight-line flow to the foot. Results At 6 months and 1, 2, and 5 years, the repeat intervention-free rates were 55.0, 49.6, 44.4, and 36.1%, respectively; the amputation-free survival rates were 85.7, 68.0, 54.5, and 39.8%, respectively; and the limb salvage rates were 96.0, 92.4, 86.3, and 86.3%, respectively. An infectious wound was an independent predictor of major amputation after successful intervention. The complete wound healing rates were 36.8, 57.5, 67.9, and 73.6% at 3, 6, 9, and 12 months, respectively. In stepwise multivariate Cox analysis, diabetes mellitus, an infectious wound, and the pedal arch classification were identified as independent predictors of wound healing. The long-term survival rates at 6 months and 1, 2, and 5 years were 89.5, 73.8, 62.0, and 43.4%, respectively. Stepwise multivariate Cox analysis indentified end-stage renal disease (ESRD) on hemodialysis to be an independent predictor of death. Conclusions An infectious wound, comorbidities of diabetes mellitus and ESRD on hemodialysis and classification of pedal arch can be predictors of adverse clinical outcomes after successful infrapopliteal intervention. © 2012 Wiley Periodicals, Inc. Copyright © 2012 Wiley Periodicals, Inc.