Treating More Than One Tibial Arteries in Patients with Chronic Limb Threatening Ischaemia is Associated with Fewer Major Re-interventions.
OBJECTIVE It is unclear whether treating multiple diseased tibial arteries at initial revascularisation improves outcomes with chronic limb threatening ischaemia (CLTI). Using data from the Best Endovascular versus Best Surgical Therapy in Patients with CLTI (BEST-CLI) trial this study aimed to compare single arterial intervention (SAI) with multiple arterial intervention (MAI) for infrapopliteal disease. METHODS A retrospective, as treated analysis of the endovascular dataset from the BEST-CLI trial was undertaken to compare SAI with MAI. Only patients with multiple tibial vessel arterial occlusive disease with > 50% stenosis were included. Evaluated outcomes included major re-interventions (new bypass, interposition graft, thrombectomy, or thrombolysis), major adverse limb events (MALE)/death, and above ankle amputations. Risk adjusted analysis was performed. RESULTS There were 324 patients included: 224 SAI and 100 MAI. On unadjusted analysis at 3 years, SAI had a higher rate of a major re-intervention (19.2% vs. 5.3%; p = .010) and MALE/death (56.4% vs. 43.6%; p = .030), while there was no difference for above ankle amputation (19.7% vs. 13.1%; p = .14), amputation/death (45.2% vs. 43%; p = .53), or all cause death (37.7% vs. 33.5%, p = .57). SAI and MAI were associated with similar rates of resolution of initial CLTI symptoms (75.9% vs. 86%; p = .60). On risk adjusted analysis, SAI was associated with a higher rate of major re-intervention (odds ratio [OR] 3.14, 95% confidence interval [CI] 1.2 - 8.2; p = .019) than MAI; however, there was no increase in any re-intervention (OR 0.95, 95% CI 0.6 - 1.49; p = .80), MALE/death (OR 1.27, 95% CI 0.86 - 1.89; p = .24), above ankle amputation (OR 1.53, 95% CI 0.74 - 3.19; p = .25), initial CLTI resolution (OR 1.16, 95% CI 0.85 - 1.59; p = .36), or death (OR 1.03, 95% CI 0.64 - 1.63; p = .90). CONCLUSION In patients with diffuse tibial arterial occlusive disease, treatment of multiple tibial arteries rather than just one at the time of index revascularisation was associated with fewer major re-interventions and should be considered.