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The following is a summary of “Indications and Treatment Outcomes of Below-the-Knee Peripheral Artery Interventions in the XLPAD Registry,” published in the May issue of American Journal of Cardiology by Rosol et al. 

Researchers conducted a retrospective study to examine the indications and outcomes of endovascular below-the-knee (BTK) interventions in individuals with symptomatic peripheral artery disease (PAD) in routine clinical settings.  

They evaluated 884 individuals from the multicenter Excellence in (XLPAD) registry who underwent non-stent BTK PAD interventions between 2006 and 2023. The primary outcome was freedom from major adverse limb events (MALE) at 1 year, defined as a composite of all-cause mortality, major amputation, or clinically driven revascularization.  

The results showed that 62.8% of BTK interventions were performed for chronic limb threatening ischemia (CLTI), while 37.2% were for intermittent claudication (IC), with 58% conducted alongside femoropopliteal artery inflow procedures and 11.8% involving complex lesion crossings. Males accounted for 74% of cases, with a mean age of 68.0 ± 10.7 years. The average Rutherford class was 4.65 in the CLTI group and 2.71 in the IC group. Moderate to severe arterial calcification was present in 25% of cases. The number of lesions treated was significantly greater in the CLTI group (2.08 ± 1.61 vs 1.84 ± 1.52; P=0.029), while lesion lengths were similar (CLTI: 129.3 ± 85.1 mm vs IC: 115.5 ± 82.5 mm; P=0.075). Balloon angioplasty was used in 92% of lesions. Drug-coated balloon use was more frequent in IC (15% vs 5%; P<0.001), and atherectomy was used in both groups (CLTI: 45.4% vs IC: 49.9%; P=0.201). Procedural success rates were comparable (CLTI: 92% vs IC: 88.8%; P=0.098) and the 1-year MALE were significantly higher in CLTI (30.5% vs 15.8%; P<0.001), largely due to increased all-cause mortality (5.6% vs 2.1%; P=0.014) and major amputations (14% vs 3.7%; P<0.001).  

Investigators concluded that endovascular treatment for BTK peripheral artery disease was more frequently performed in individuals with CLTI, with significantly higher 1-year MALE driven by increased all-cause mortality and major amputations. 

Source: ajconline.org/article/S0002-9149(25)00311-X/abstract