Efficacy And Long-term Primary Patency Prognostic Factors After Endovascular Therapy For ALI

Objective: To assessed prognostic factors regarding efficacy and long-termprimary patency for patients who underwent intra-arterial thrombolysis and/oradjuvant endovascular techniques due to acute lower limb ischemia. And to providescientific proof for raising the efficacy and long-term primary patency of the patientby controlling the crisis factors.Methods: Consecutive patients with ALI of the lower extremities treated viainterventional methods between January1,2005and October2010of Department ofInterventional Radiology, Nanjing First Hospital Affiliated to Nanjing MedicalUniversity were identified and reviewed. Analysis of sex，age，smoking，otherchronic comorbidities (Hypertension, Diabetes mellitus, PAOD, Atrial fibrillation),onset time, location，scale，treatment method and thrombolysis time were carried out.Analyze the potential clinical factors associated with efficacy using chi-square test.Total Long-term primary patency and grouped primary patency were assessed usingKaplan-Meier estimation, and Log-rank test was used for comparison among groups.Only factors associated with Long-term primary patency with a P value less than0.1in univariable analysis were introduced into the Cox regression mode.Results: The analyzed dataset included117limbs treated in109patientspresenting with ALI (class I9, class IIa45,class IIb-III63，according to Rutherfordclassification). Technical success was achieved in84.6%cases.89limbs wereenrolled in follow-up. The mean follow-up was34.3months (range:0-53months).Analyses identified that Hypertension (χ2=6.59, P=0.01), PAOD (χ2=5.77, P=0.02),long-time thrombolysis (f=10.52, P=0.00)、 High-level of Rutherfordclassification(f=6.92, P=0.02) and lesions located in tibial and multilevel negatively(f=16.48, P=0.00) effect the efficacy of treatment. primary patency at12,24and36months was87%,68%and55%, respectively. Univariable analyses identified age, hypertension, Diabetes mellitus, auricular fibrillation, and thrombolysis time relatedwith primary patency（P<0.05）. Multivariable analyses identified patients presentingwith Diabetes mellitus (HR=0.275，95%CI0.108-0.702， P=0.00)， PAOD(HR=0.366，95%CI0.160-0.839，P=0.02) and thrombolysis time (HR=1.983，95%CI1.102-3.570，P=0.02) were associated with primary patency.Conclusions: Interventional theraPy remains an effective treatment oPtion forpatients presenting with lower extremity ALI. Hypertension, PAOD, lesion location,Rutherford classification and thrombolysis were associated with efficacy. Diabetesmellitus and PAOD negatively affect the rates of limb primary patency. Earlierdiagnosis and treatment could improve the prognosis. It is important to observe thechange of patient’s condition carefully, especially the patients with risk factors andthrombolysis should be limited to <4days.