Patient-specific risk factors for reintervention following primary endovascular treatment of iliac artery disease.

Köckerling, David; Zielasek, Christian; Stähli, Patrick; Wohlfarth, Benny; Rosenov, Alexander; Helfenstein, Fabrice; Behrendt, Christian-Alexander; Baumgartner, Iris (2024). Patient-specific risk factors for reintervention following primary endovascular treatment of iliac artery disease. Journal of vascular surgery, 79(4), 847-855.e5. Elsevier 10.1016/j.jvs.2023.12.012

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OBJECTIVES

Predictive models for reintervention may guide clinicians to optimize selection, education and follow-up of patients undergoing endovascular iliac revascularization. While 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

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%CI 0.50-0.83, p=0.001] and decreased risk of CD-TVR at any given time [hazard ratio (HR) 0.66, 95%CI 0.52-0.84, p=0.001]. Similarly, a lower likelihood of CD-TVR (OR 0.75, 95%CI 0.59-0.95, p=0.017) and decreased risk of CD-TVR at any given time (HR 0.73, 95%CI 0.58-0.93, p=0.009) 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=0.030) and decreased risk of CD-TVR at any given time (HR 0.48, 95%CI 0.25-0.92, p=0.027). No associations were observed between traditional cardiovascular risk factors (sex, hypertension, higher low-density lipoprotein cholesterol, higher haemoglobin A1c, smoking) and CD-TVR.

CONCLUSION

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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