Article ; Online: Patient-specific risk factors for reintervention following primary endovascular treatment of iliac artery disease.
2023 Volume 79, Issue 4, Page(s) 847–855.e5
Abstract: Objective: Predictive models for reintervention may guide clinicians to optimize selection, education, and follow-up of patients undergoing endovascular iliac revascularization. Although the impact of lesion- and device-related characteristics on iliac ... ...
| Abstract | Objective: Predictive models for reintervention may guide clinicians to optimize selection, education, and follow-up of patients undergoing endovascular iliac revascularization. Although the impact of lesion- and device-related characteristics on iliac restenosis and reintervention risk is well-defined, data on patient-specific risk factors are scarce and conflicting. This study aimed to explore the value of patient-related factors in predicting the need for clinically driven target-vessel revascularization (CD-TVR) in patients undergoing primary endovascular treatment of iliac artery disease. Methods: Consecutively enrolled patients undergoing endovascular revascularization for symptomatic iliac artery disease at a tertiary vascular referral center between January 2008 and June 2020 were retrospectively analyzed. Primary and secondary outcomes were CD-TVR occurrence within 24 months and time to CD-TVR, respectively. Patients who died or did not require CD-TVR within 24 months were censored at the date of death or at 730 days, respectively. Multiple imputation was used to account for missing data in primary analyses. Results: A total of 1538 iliac interventions were performed in 1113 patients (26% females; 68 years). CD-TVR occurred in 108 limbs (74 patients; 7.0%) with a median time to CD-TVR of 246 days. On multivariable analysis, increasing age was associated with lower likelihood of CD-TVR (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.50-0.83; P = .001) and decreased risk of CD-TVR at any given time (hazard ratio [HR], 0.66; 95% CI, 0.52-0.84; P = .001). Similarly, a lower likelihood of CD-TVR (OR, 0.75; 95% CI, 0.59-0.95; P = .017) and decreased risk of CD-TVR at any given time (HR, 0.73; 95% CI, 0.58-0.93; P = .009) were observed with higher glomerular filtration rates. Lastly, revascularization of common vs external iliac artery disease was associated with lower likelihood of CD-TVR (OR, 0.48; 95% CI, 0.24-0.93; P = .030) and decreased risk of CD-TVR at any given time (HR, 0.48; 95% CI, 0.25-0.92; P = .027). No associations were observed between traditional cardiovascular risk factors (sex, hypertension, higher low-density lipoprotein cholesterol, higher hemoglobin A1c, smoking) and CD-TVR. Conclusions: In this retrospective cohort study, younger age, impaired kidney function, and external iliac artery disease were associated with CD-TVR. Traditional markers of cardiovascular risk were not seen to predict reintervention. |
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| MeSH term(s) | Female ; Humans ; Male ; Iliac Artery/diagnostic imaging ; Iliac Artery/surgery ; Retrospective Studies ; Treatment Outcome ; Endovascular Procedures/adverse effects ; Risk Factors ; Peripheral Arterial Disease/diagnostic imaging ; Peripheral Arterial Disease/therapy ; Peripheral Arterial Disease/etiology |
| Language | English |
| Publishing date | 2023-12-14 |
| Publishing country | United States |
| Document type | Journal Article |
| ZDB-ID | 605700-7 |
| ISSN | 1097-6809 ; 0741-5214 |
| ISSN (online) | 1097-6809 |
| ISSN | 0741-5214 |
| DOI | 10.1016/j.jvs.2023.12.012 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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