On the one hand, chronic peripheral vascular disease is on the rise. On the other, over the past 20 years, percutaneous coronary intervention (PCI) has gained considerable ground thanks to various new devices, replacing surgery as an alternative in most scenarios. Both strategies have shown similar results, but PCI has fewer complications and shorter hospital stays.
However, available information on this disease comes mainly from Europe and the United States, and data on its incidence in our region is scarce. This limitation hinders our understanding of the local reality and the potential alternatives regarding strategies.
To address this lack of information, the SOLACI Peripheral Registry was subjected to an analysis in a prospective, multicenter study that included 997 patients with 1057 lesions.
The primary endpoint of the study was the combined outcome of all-cause death, fatal and non-fatal myocardial infarction, stroke, vessel or stent thrombosis, access site complications, bleeding, and in-hospital emergency reinterventions.
Mean patient age was 69 years and 65% of subjects were men. About 85% had hypertension, 67% dyslipidemia, 65% diabetes (most of these patients required insulin), 58% were smokers, and 17% of all cases had a history of acute myocardial infarction, 21% had a history of percutaneous transluminal coronary angioplasty (PTCA) or myocardial revascularization surgery (MRS), 22% had undergone previous peripheral transluminal angioplasty (PTA), 6% had undergone a previous peripheral bypass, 5.5% required dialysis, and 15% had undergone a previous amputation.
Read also: ACC 2024 | ORBITA-COSMIC.
Additionally, 7% of all cases experienced severe claudication, 31% had rest pain, 45% had tissue lesions due to ischemia, 36% had infection, and the ankle-brachial index (ABI) was <5 in 24% of cases.
Femoropopliteal disease was the most common disease, followed by infrapopliteal, and—less frequently—iliofemoral. About 27.6% of patients underwent PTA in more than one territory.
Read also: ACC 2024 | IVUS-DCB.
Lesion length ranged from 2 mm to 450 mm; the longest ones were infrapopliteal. The most severe calcifications were iliofemoral, and atherectomy was used on femoropopliteal disease in 4.4% of cases. Stenting was more common in the case of iliofemoral disease, while balloon PTA was more common in infrapopliteal disease, where stenting was only used as a bailout strategy.
At the hospital level, all-cause mortality was 1.3%, cardiovascular mortality 0.7%, myocardial infarction 0.4%, stroke 0.1%, significant bleeding 0.8%, and thrombosis 1.9%.
Conclusion
Real-world data on chronic peripheral vascular disease in Latin America could help identify unknown needs and generate evidence-based recommendations to facilitate the development of prevention and treatment strategies tailored to each country and its available resources.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.
Original Title: Rationale and Design of the Latin-American Registry of Peripheral Interventions: Insights From SOLACI Peripheral.
Reference: Luis R. Virgen Carrillo, et al. JSCAI Article in Press https://doi.org/10.1016/j.jscai.2024.101931.
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