In endovascular treatment (EVT) for chronic total occlusion (CTO) in the superficial femoral artery (SFA), procedures with incomplete ankle-brachial index (ABI) and/or avoiding stent placement were associated with worsening ABI at follow-up, according to a presentation by Dr. Yutaka Tadano, Sapporo Cardiovascular Clinic, at the e-Abstract session of ACC 22.
The Factors That Contribute to a Long-Lasting Therapeutic Effect after Endovascular Therapy for SFA-CTO
The study consisted of 200 consecutive patients (257 limbs) with successful EVT for SFA- CTO lesions at a single institution from January 2013 to May 2017. Among them, at a median follow-up of 20 months, 144 limbs were measured with ABI and divided into two groups. The decreased ABI group (42 limbs, 29%) with ABI ≥0.2 lower at follow-up was compared to the preserved ABI group (102 limbs, 71%) where ABI was sustained. Factors associated with ABI persistence were measured across 25 characteristics, including history of ischemic heart disease, lesion complexity, and procedural details.
Preprocedural ABI did not differ between the decreased and preserved groups (0.64 vs 0.63: p=0.67); factors with p values <0.20 were male (45% vs 64%: p=0.04), hypertension (86% vs 73%: p=0.08), maximum balloon diameter (5.1mm vs 5.2mm: p=0.16), and stent use (43% vs 69%: p=0.004), and ABI ≥0.9 immediately after EVT (76% vs 51%: p=0.004).
From these factors, multivariate analysis confirmed stent use (OR 3.7 [95% CI 1.7-8.8] p=0.001) and ABI <0.9 immediately after EVT (OR 4.5 [95% CI 1.9-11.7] p=0.0005) as predictors of preserved ABI at follow-up.
Dr. Tadano summarized, “Avoiding stent placement, including bare metal stents, as well as incomplete procedures with an ABI <0.9 were associated with worsening ABI at follow-up. Other factors, such as coronary risk, calcification, and the length of occlusion were not associated with a decrease in ABI.”
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