Outcomes of repeat below the knee endovascular therapy: report and WIFI score

Thanks, as always to the original SALSAmigo, Prof. Joseph LR Mills for this find from Kobayashi and coworkers. Does this fit with your experiences?screenshot 2017-08-16 at 7.30.47 AM.JPG


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Objectives: We clarified characteristics and clinical outcomes of critical limb ischemia (CLI)
patients who underwent repeat endovascular therapy (EVT) for infrapopliteal lesions.
Background: High restenosis rate after infrapopliteal EVT remains a major concern.
Methods: Patients with CLI who underwent EVT between April 2007 and February 2014, were divided into the following three groups according to how often EVT was repeated: Group A, no repeat of EVT; Group B, EVT repeated once/twice; and Group C, EVT repeated 3 times.
Results: Wound healing rates at 1 year were 93.9% in Group A, 77.1% in Group B, and 27.3% in Group C (P<0.001). Limb salvage rates at 3 years were 93.0, 88.5, and 57.1%, respectively (P50.001). Amputation-free survival rates at 3 years were 60.8, 51.2, and 29.2%, respectively (P50.019). Multivariate analysis revealed that hemodialysis (OR 3.413, 95% CI 1.263–9.225, P 5 0.016), low ejection fraction (OR 7.758, 1.049–57.360, P 5 0.045), and clinical stage assessed by SVS WIfI (OR 2.440, 1.417–4.203, P 5 0.001) were independent predictors of repeat EVT. The rate of requirement for repeat EVT significantly increased as clinical stage became more severe (repeat EVT rate: 0% in CS 1, 28.6% in CS 2, 34.0% in CS 3, and 45.7% in CS 4, P < 0.001).
Conclusions: The clinical outcomes of CLI patients requiring repeat EVT three or more times were poor. The SVS WIfI clinical stage may be useful to predict the necessity of repeat EVT.

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