Prognostic impact of Lesion Subset with or without below the Knee Lesion in Chronic Limb-Threatening Ischemia following Endovascular Revascularization

AIMS: The aim of this study is to evaluate the impact of each level atherosclerotic lesion subset on clinical outcomes following EVT in CLTI patients. METHODS: We identified 705 consecutive CLTI patients undergone successful EVT between January 2010 and December 2019 at our hospital in Japan. The technical success was defined as the acquisition of one straight line flow to the ulcerated or gangrenous region. We excluded 15 patients with follow up ＜30days. The primary endpoint was major adverse limb event (MALE) at 2 years after EVT. MALE was defined as composite of all cause death and major amputation (MA). MA was defined as an above-the-ankle amputation. RESULTS: The median follow-up duration was 24.4 months. MALE rate was significantly higher in BK group (adjusted HR 1.48, 95% CI, 1.04-2.10 p = 0.028). Cardiovascular mortality was significantly higher in BK group (adjusted HR 1.94, 95% CI, 1.06-3.56 p = 0.031). Isolated BK lesions were identified an independent predictor of MA (adjusted HR 2.12, 95% CI, 1.01-4.48 p = 0.048). CONCLUSION: In CLTI patients who received EVT, those with BK lesions were associated with poorer clinical outcomes after EVT than those without BK lesion, mainly due to increased cardiovascular death. Additionally, isolated BK lesion was associated with higher MA rate after EVT than both FP and BK lesions or isolated FP lesions in our study population.