Conference Coverage

Endovascular interventions associated with large benefits in peripheral artery disease

 

Key clinical point: An observational study supports endovascular strategies even in the most advanced cases of peripheral artery disease (PAD).

Major finding: In Rutherford stage 6 patients, low amputation rates and large improvements in quality of life were observed at 18 months of follow-up.

Data source: Prospective, observational multicenter study.

Disclosures: Dr. Gray reports financial relationships with Abbott Vascular, BioCardia, Boston Scientific, Cardiovascular Systems, Coherex Medical, Contego Cook, Cordis, Medtronic, Shockwave Medical, Silk Road Medical, and WL Gore.


 

REPORTING FROM CRT 2018

– An all-comer observational study associated endovascular treatment of lower limb peripheral artery disease (PAD) with low event rates and substantial improvements in quality of life at 18 months, even in Rutherford stage 6 patients.

Although the proportion of patients with Rutherford stage 6 PAD was relatively small, the study results showed that peripheral vascular intervention “can be successful in this patient population as evidenced by a high freedom from major amputation,” reported William Gray, MD, system chief of the division of cardiovascular disease at the Lankenau Heart Group, Wynnewood, Pa., at CRT 2018, sponsored by the Cardiovascular Research Institute at Washington Hospital Center.

Ted Bosworth/MDedge News

Dr. William Gray

After 18 months of follow-up in the LIBERTY 360 study, 82% of patients with Rutherford stage 6 disease, which is the most severe stage of PAD, were free from major amputation. The figure for a combined endpoint of freedom from amputation and death was 64%. The mortality at 18 months in the Rutherford stage 6 patients, reflective of a very-high-risk population, was 24%.

“Many of the patients in this trial, particularly the Rutherford 6 patients, would never be included in the pivotal trial for endovascular devices,” Dr. Gray said. He called this “a unique study” in that it had almost no exclusions.

The study enrolled 1,204 patients with peripheral artery disease at 51 participating sites. After 18 months, follow-up data were available on 793 patients. These were divided by Rutherford classifications into three groups: 374 patients in the combined Rutherford 2 and 3 classifications (R2/3); 371 in the combined Rutherford 4 and 5 classifications (R4/5); and 48 in the Rutherford 6 classification (R6). Patients treated with any Food and Drug Administration–approved technology for treatment of claudication and critical limb ischemia for PAD were eligible.

The endpoints considered at 18 months included procedural and lesion success, major adverse events, and quality of life. Four core laboratories were responsible for an independent analysis of outcomes. A follow-up of 5 years is planned and will include an economic analysis.