Dynamics of below-the-knee arterial blood flow after endovascular revascularization of peripheral arteries as a potential predictor of clinical outcomes during a one-year follow-up period

Background: Patients with advanced lower limb ischemia are at present, mainly treated using revascularization. Aim: The aim of the study was to investigate whether the dynamics of blood flow in below-the-knee (BTK) arteries assessed at angiogram completion correlate with clinical outcomes after a 12-month follow-up period among patients with severe leg ischemia treated percutaneously. Methods: The current study enrolled 287 consecutive patients who underwent 302 endovascular procedures on the infra-inguinal arteries. The mean age of the included participants was 67.4 ± 10.4 years. After the procedure, blood flow of all patent BTK arteries was assessed using frame count (FC). Patients were then evaluated after 1, 3, 6 and 12 months. During the follow-up visits, clinical condition was evaluated based on the Rutherford scale, ankle-brachial index, the need for reintervention and amputation. Results: Clinical improvement at the end of the follow-up period was observed in 242 cases (80.1%) and no improvement or worsening in 42 (13.0%). In total, 66 reinterventions (21.8%) and 18 (6%) amputations during the follow-up period were recorded. Patients with higher FC on the tibial anterior artery experienced significantly better clinical improvement within the 12-month follow-up period (p = 0.02). Lower FC predisposed to worse clinical outcomes after angioplasty. Similar tendencies were found for the tibial posterior and fibular artery, however, without statistical significance. Conclusions: The results suggest a negative relationship between FC seen on the final angiogram and clinical outcomes in patients undergoing endovascular treatment of the peripheral arteries.