Key result
Below-the-knee lesions are linked to ~48% higher MALE risk after EVT in CLTI.
Why the study?
The impact of lesion subsets, specifically below the knee lesions, on clinical outcomes following EVT in CLTI patients was not well defined.
Does the presence of below the knee (BK) lesions worsen major adverse limb events in CLTI patients undergoing endovascular therapy compared to isolated femoropopliteal lesions?
Observational (n=690)
No
Does the presence of below the knee (BK) lesions worsen major adverse limb events in CLTI patients undergoing endovascular therapy compared to isolated femoropopliteal lesions?
Hazard Ratio: 1.48 (95% CI 1.04–2.1)
Absolute Event Rate: 60% vs 41.7%
p-value: p=0.028
In patients with chronic limb-threatening ischemia undergoing endovascular therapy, the presence of below-the-knee lesions is associated with significantly worse clinical outcomes, including higher rates of major adverse limb events and cardiovascular death, compared to isolated femoropopliteal lesions.
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May inform lesion-based risk stratification in CLTI; leaves open whether anatomy-specific strategies improve limb outcomes.
Watanabe et al. (2026) conducted an observational in Chronic limb-threatening ischemia (n=690). Below the knee (BK) lesions vs. Isolated femoropopliteal (FP) lesions was evaluated on Major adverse limb event (MALE) at 2 years (HR 1.48, 95% CI 1.04-2.10, p=0.028). Below-the-knee lesions significantly increased major adverse limb events after endovascular therapy in chronic limb-threatening ischemia compared to isolated femoropopliteal lesions (adjusted HR 1.48).
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