Clinical impact of the infrapatellar location in symptomatic peripheral arterial disease patients

Juan G. Chiabrando, Department of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Fernando D. Garagoli, Department of Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Maria M. Abraham Foscolo, Department of Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Giuliana Corna, Department of Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Maria de los Milagros Fleitas, Department of Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Juan Valle Raleigh, Department of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Horacio A. Medina-de Chazal, Department of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Daniel H. Berrocal, Department of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
José M. Rabellino, Department of Digital Angiography, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Ignacio M. Bluro, Department of Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

Background: Peripheral artery disease (PAD) frequently affects multiple segments of the limbs. Contradictory data have reported worse prognosis in aortoiliac lesions, nevertheless, diabetes and chronic limb ischemia frequently affects the infrapatellar territory. Our aim was to assess the impact of infrapatellar disease in cardiovascular outcomes. Methods: We performed a retrospective, observational cohort study at a university hospital in Argentina. Electronic health records were retrospectively reviewed including symptomatic PAD patients requiring revascularization. A multivariable regression model was performed to account for confounders. The primary endpoint was a composite of hospitalizations due to chronic limb threatening ischemia (CLTI) and major amputation events between infrapatellar and suprapatellar patients. Minor amputation events, all-cause death, myocardial infarction (MI), stroke, and major cardiovascular events (MACE) were secondary endpoints. Results: From January 2014 through July 2020, a total of 309 patients were included in the analysis. 151 patients had suprapatellar disease, and 158 had infrapatellar disease. The primary composite endpoint occurred in 35 patients (22.2%) in the infrapatellar patients and 18 patients (11.9%) in the suprapatellar patients (HR = 2.16; 95% confidence interval [CI]= [1.22-3.82]; p = 0.008). Both components of the primary outcomes occurred more frequently in infrapatellar patients.Minor amputation events were more prevalent in infrapatellar patients (HR = 5.09; 95% CI = [1.47-17.6]; p = 0.010). Death,MI, stroke, and MACE events were not different among groups (all p > 0.05). Conclusion: Infrapatellar disease was anindependent factor for increased hospitalization of CLTI, major and minor amputations events, compared to suprapatellardisease in symptomatic revascularized PAD patients.

Palabras clave: Peripheral artery disease. Infrapatellar. Claudication. Chronic limb-threatening ischemia. Acute ischemia.