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Distal embolization during lower extremity endovascular interventions.
- Source :
-
Journal of vascular surgery [J Vasc Surg] 2017 Jul; Vol. 66 (1), pp. 143-150. Date of Electronic Publication: 2017 Mar 30. - Publication Year :
- 2017
-
Abstract
- Objective: Distal embolization (DE) during peripheral arterial endovascular interventions is a well-known complication that is poorly studied. The goal of this study was to determine the incidence, risk factors, and effect of DE on the outcomes of lower extremity endovascular interventions (LEIs).<br />Methods: All LEIs between 2010 and 2014 in the Vascular Study Group of New England (VSGNE) database were reviewed. Patient characteristics were analyzed to determine predictors of DE. LEIs involving the superficial femoral artery (SFA) were reviewed to assess the effect of type of treatment on DE. The outcomes examined were loss of patency, limb loss, and mortality after LEI involving the SFA. A multivariable regression was used to determine predictors of DE.<br />Results: There were 10,875 procedures. The incidence of DE was 17.3 per 1000 procedures, and 68% required treatment (57% endovascular, 11% open surgery). DE was more common in patients treated for critical limb ischemia compared with claudication (relative risk [RR], 2.06; 95% confidence interval [CI], 1.24-3.45; P = .006) and for emergency interventions compared with elective (RR, 2.98; 95% CI, 1.22-7.30; P = .017). DE increased with the number of arteries treated (P < .0001) and with the length of occlusion (P < .0001). The SFA was the most commonly treated artery (4751 [43.7%]). In comparison with atherectomy and balloon angioplasty, stenting alone (RR, 0.36; 95% CI, 0.17-0.73; P = .005), balloon angioplasty alone (RR, 0.23; 95% CI, 0.13-0.41; P < .0001), and combined stenting and balloon angioplasty (RR, 0.29; 95% CI, 0.17-0.49; P < .0001) were associated with a significantly lower risk of DE. DE was not significantly associated with loss of patency, major amputation, or mortality.<br />Conclusions: The incidence of DE during LEIs is 1% to 2% in the VSGNE database, and most patients are treated with additional endovascular interventions. The incidence increases in patients with critical limb ischemia and with the use of atherectomy.<br /> (Copyright © 2017 Society for Vascular Surgery. All rights reserved.)
- Subjects :
- Aged
Amputation, Surgical
Angioplasty, Balloon instrumentation
Angioplasty, Balloon mortality
Atherectomy mortality
Chi-Square Distribution
Critical Illness
Databases, Factual
Disease-Free Survival
Embolism diagnosis
Embolism physiopathology
Female
Humans
Incidence
Intermittent Claudication diagnosis
Intermittent Claudication mortality
Intermittent Claudication physiopathology
Ischemia diagnosis
Ischemia mortality
Ischemia physiopathology
Limb Salvage
Male
Middle Aged
Multivariate Analysis
New England epidemiology
Odds Ratio
Peripheral Arterial Disease diagnosis
Peripheral Arterial Disease mortality
Peripheral Arterial Disease physiopathology
Proportional Hazards Models
Registries
Retrospective Studies
Risk Assessment
Risk Factors
Stents
Time Factors
Treatment Outcome
Vascular Patency
Angioplasty, Balloon adverse effects
Atherectomy adverse effects
Embolism epidemiology
Femoral Artery physiopathology
Intermittent Claudication therapy
Ischemia therapy
Lower Extremity blood supply
Peripheral Arterial Disease therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6809
- Volume :
- 66
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Journal of vascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 28366300
- Full Text :
- https://doi.org/10.1016/j.jvs.2017.01.032