Determinants of Peri-Procedural Mechanical Complications During Peripheral Endovascular Revascularization: Insights from Single-Center Experience

Background: Peripheral endovascular intervention is the preferred revascularization strategy for patients with chronic lower-limb ischemia. Although generally safe, peri-procedural mechanical complications may occur and are influenced by both lesion complexity and procedural strategy. Data identifying determinants of such complications in routine clinical practice remain limited. Methods: We performed a retrospective single-center analysis of consecutive patients undergoing peripheral endovascular intervention for chronic lower-limb ischemia between 2010 and 2023. The primary endpoint was the occurrence of peri-procedural mechanical complications, defined as mechanical adverse events occurring during or immediately following the index intervention and directly related to catheter manipulation, device deployment, or vascular access. Lesion- and procedure-related predictors were evaluated using multivariable logistic regression analysis. Results: A total of 283 index procedures were included. Peri-procedural mechanical complications occurred in 9 procedures (3.2%), with arterial dissection being the most frequent event (2.1%). No cases of peri-procedural bleeding, distal embolization, or emergent surgical conversion were observed. In multivariable analysis, chronic total occlusion (adjusted odds ratio [aOR] 1.89, 95% confidence interval [CI] 1.14–3.11; p = 0.014), moderate-to-severe arterial calcification (aOR 1.74, 95% CI 1.03–2.93; p = 0.039), introducer sheath size ≥7 French (aOR 2.08, 95% CI 1.21–3.57; p = 0.007), and ≥3 vascular access attempts (aOR 1.67, 95% CI 1.00–2.81; p = 0.048) were associated with increased risk of peri-procedural mechanical complications in adjusted analyses. Conclusions: In this real-world institutional registry, peri-procedural mechanical complications during peripheral endovascular intervention were uncommon. Lesion complexity and procedural factors, rather than access route or device type, were the primary determinants of mechanical risk. These findings highlight the importance of careful lesion assessment and procedural planning to optimize peri-procedural safety in routine practice.