Outcomes of Endovascular Interventions for Peripheral Arterial Disease Stratified by Rutherford Classification

Purpose:
The 12-month results of the LIBERTY 360 (NCT01855412) study have been previously published and supported endovascular therapy as a viable treatment option for Rutherford classes (RC) 2-3, RC 4-5, and even RC 6 patients. Thus the scope of this study was to report the 3-year results of the LIBERTY 360 study, investigating endovascular outcomes of the treatment of all symptomatic RC from RC 2-6.

Material and Methods:
Hazard ratios and respective 95% confidence intervals were synthesized to examine the association between Rutherford category (RC) at baseline and late-term outcomes over a 3-year follow up period.

Results:
Data from 1,189 (RC 2-3:500; RC 4-5:589; RC 6:100) patients were analyzed. The 36-month Kaplan Meier (KM) survival rates were respectively 86.0% in RC 2-3, 79.8% in RC 4-5 and 62.0% in RC 6 groups, with significant differences among all 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 target vessel/lesion revascularization were 71.1% in RC 2-3, 64.7% in RC 4-5 and 61.9% in RC 6 groups. Patients with claudication at baseline were at lower risk for MAE, all-cause death, major amputation, and major amputation/death compared to RC 4-5 and RC 6 patients during 36-month follow up. Vascular quality of life as measured by VascuQoL improved from baseline and was maintained at 12-, 24- and 36-months among all patients.

Conclusions:
Endovascular therapy is a viable treatment option for patients with symptomatic PAD, with acceptable three-year freedom from major amputation rates and sustained improved quality of life in both claudication and chronic limb threatening ischemia. These results provide important point estimates for long-term outcomes after modern endovascular interventions for PAD.