Three-Year Outcomes From the LIBERTY 360 Study of Endovascular Interventions for Peripheral Artery Disease Stratified by Rutherford Category

Abstract

Purpose: To report the 3-year results of the LIBERTY 360 study, which investigated outcomes of endovascular treatment of symptomatic peripheral artery disease (PAD). Materials and Methods: The LIBERTY trial ( ClinicalTrials.gov identifier NCT01855412) was a prospective, observational, core laboratory–assessed, multicenter study of endovascular interventions enrolling >1200 participants treated at 51 sites. Data from 1189 patients were stratified according to Rutherford category (RC) and analyzed [RC 2-3 (n=500), RC 4-5 (n=589), and RC 6 (n=100)]. The primary outcomes were major amputation of the target limb and all-cause death; secondary outcomes were target vessel revascularization (TVR) or target lesion revascularization (TLR); major adverse events (MAEs; death within 30 days, TVR or TLR, and major amputation); death or major amputation combined; and change in self-reported quality of life (QoL) measures (VascuQol-25). The Kaplan-Meier (KM) method was employed to estimate the outcomes; estimates are presented with the 95% confidence intervals (CI). Predictors of 3-year MAE, death, TVR, and major amputation were analyzed using Cox proportional hazard regression modeling. Results: The 36-month KM survival rates were 86.0% in RC 2-3, 79.8% in RC 4-5, and 62.0% in RC 6 groups. The KM estimates of freedom from major amputation at 36 months were 98.5% in RC 2-3, 94.0% in RC 4-5, and 79.9% in RC 6. The 36-month KM estimates for freedom from TVR/TLR were 71.1% in RC 2-3, 64.2% in RC 4-5 and 61.9% in RC 6 groups. Patients with claudication at baseline were at lower risk for MAEs compared with RC 4-5 and RC 6 patients during the 36-month follow-up. Vascular QoL improved from baseline and persisted up to 36 months in all patients. Conclusion: Endovascular therapy is a viable treatment option for patients with symptomatic PAD, with sustained improved quality of life in both claudicants and patients with chronic limb-threatening ischemia. These results provide important point estimates for midterm outcomes after modern endovascular interventions for PAD.

Advances in Revascularization for Peripheral Artery Disease: Revascularization in PAD

“…105 Atherectomy may be useful to create a lumen in a calcified vessel. 106 Whereas iliac and FP lesions are treated with the hope of longer-term patency in patients often presenting with IC, tibial lesions are usually treated with the hopes of providing adequate perfusion over a period of months to heal a foot wound. However, patients with more extensive tissue loss, or those with ischemic rest pain, generally require durable hemodynamic improvement to resolve CLTI.…”

Measuring Quality of Life in Chronic Limb-threatening Ischemia Patients and Informal Carers: A Scoping Review

“…Of 6470 records identified in the primary database search, 114 studies25–138 were included. An additional 16 studies139–154 were included from the secondary database search and 16 studies155–170 from the reference list search.…”

“…There were 97 studies [25][26][27][28][29]32,33,[35][36][37][38][39][40][42][43][44][46][47][48][49][50][51][52][54][55][56][57][58][59][60][61][62][64][65][66][67][68][69][70][72][73][74][75][76][77][78][79]81,82,[84][85][86][87]…”

Specialty Balloons for Vessel Preparation During Infrainguinal Endovascular Revascularization Procedures: A Review of Literature

“…EVT has been increasingly preferred over open surgical revascularization for the treatment of lower limb PAD, due to faster recovery to functional status, superior periprocedural safety, and acceptable long-term patency, 17 although recent evidence suggested higher amputation rates in patients with more advanced, complex disease (ie, CLI) compared to bypass surgery. 18,19 EVT restores arterial blood flow to ischemic tissues, improving symptoms, likely also delaying/preventing disease progression and as such the need for major amputations.…”

“…1 Therefore, in addition to optimized medical therapy and modification of traditional atherosclerotic risk factors, revascularization procedures, including endovascular therapy (EVT) and open bypass surgery, are offered in order to increase the overall patients' functionality and prevent or limit disease progression. 1,[13][14][15][16] EVT has been increasingly preferred over open surgical revascularization for the treatment of lower limb PAD, due to faster recovery to functional status, superior periprocedural safety, and acceptable long-term patency, 17 although recent evidence suggested higher amputation rates in patients with more advanced, complex disease (ie, CLI) compared to bypass surgery. 18,19 EVT restores arterial blood flow to ischemic tissues, improving symptoms, likely also delaying/preventing disease progression and as such the need for major amputations.…”