Persistent smoking and adverse long-term outcomes after endovascular treatment for lower extremity peripheral artery disease

Aim: Long-term assessment after endovascular treatment for lower extremity peripheral artery disease (PAD) is clinically important because favorable immediate technical results may coexist with later limb and cardiovascular events. This study describes procedural and 5-year clinical outcomes in a single-center cohort.

Material and Methods: This retrospective, single-center, descriptive cohort included 150 patients treated for symptomatic lower extremity PAD between August 2016 and December 2018. Balloon angioplasty was the primary strategy; stenting was used as a bail-out treatment for suboptimal angiographic results, and directional atherectomy was used in 18 patients (12.0%). Clinical severity was summarized using the Rutherford category and the Wound, Ischemia, and Foot Infection (WIfI) stage. Follow-up consisted of clinical assessment and ankle-brachial index (ABI) measurement; median follow-up was 5 years. Fifteen patients were lost to follow-up, and five died. Because only aggregate data were available, analyses were descriptive; no patient-level smoking comparison, paired ABI test, regression model, or time-to-event analysis was performed.

Results: Most patients were Rutherford category 3 (104 [69.3%]), 4 (33 [22.0%]), or 5 (13 [8.7%]); WIfI stages 1-4 were represented. Technical success was 90.7% (136/150), and peri-procedural complications were recorded in 4.0% (6/150). Mean ABI increased descriptively from 0.4 ± 0.1 before treatment to 0.8 ± 0.2 after treatment. During follow-up, 5 patients (3.3%) died, 12 (8.0%) had myocardial infarction, 2 (1.3%) had stroke, 24 (16.0%) underwent repeat revascularization, and 8 (5.3%) underwent major amputation. Event categories were not mutually exclusive.

Conclusion: In this descriptive cohort, favorable procedural results and a higher post-procedure mean ABI coexisted with clinically important long-term limb and cardiovascular events. The study does not establish independent predictors or quantify the effect of smoking because comparative and adjusted analyses were not available. Prospective patient-level studies with standardized lesion characterization, medical-therapy documentation, imaging surveillance, and time-to-event analysis are needed.