This study aimed to investigate the relationship between anemia and restenosis in patients with femoropopliteal arterial disease following drug-coated balloon (DCB) angioplasty.
Methods
194 patients treated with DCB for femoropopliteal lesions were retrospectively analyzed for up to 12 months of follow-up between January 2017 and September 2020. Baseline clinical and procedural characteristics were compared between the anemia and non-anemia patients, and predictors of restenosis were identified using logistic regression.
Results
32.5% of the patients undergoing DCB angioplasty had anemia. Patients with anemia were significantly older, with higher rates of hypertension, coronary artery disease, chronic renal insufficiency, and diabetes, and with lower rates of smoking and male gender. In the multivariate analysis, anemia was independently and significantly associated with a higher risk of restenosis (OR, 3.872; 95% CI, 1.556–9.638; P = 0.004).
Conclusion
Anemia is independently associated with restenosis in patients treated with DCB for femoropopliteal arterial disease. Patients with lower baseline hemoglobin might have more chances to develop restenosis at follow-up.
NorgrenLHiattWRDormandyJA, et al.Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg2007; 45(suppl S): S5–S67.
2.
IidaOSogaYUrasawaK, et al.Drugcoated balloon versus uncoated percutaneous transluminal angioplasty for the treatment of atherosclerotic lesions in the superficial femoral and proximal popliteal artery: 2 year results of the MDT 2113 SFA Japan randomized trial. Catheter Cardiovasc Interv2019; 93(4): 664–672.
3.
SchneiderPALairdJRTepeG, et al.Treatment effect of drug-coated balloons is durable to 3 years in the femoropopliteal arteries: long-term results of the IN PACT SFA randomized trial. Circ Cardiovasc Interv2018; 11(1): e005891.
4.
AmbulgekarNVGreySFRosmanHS, et al.Association of anemia with outcomes in patients undergoing percutaneous peripheral vascular intervention: insights from the blue cross blue shield of michigan cardiovascular consortium (BMC2 VIC). J INVASIVE CARDIOL2018; 30(1): 35–42.
5.
VelescuAClaráACladellasM, et al.Anemia increases mortality after open or endovascular treatment in patients with critical limb ischemia: a retrospective analysis. Eur J Vasc Endovasc Surg2016; 51(4): 543–549.
6.
DesormaisIAboyansVBuraA, et al.Anemia, an independent predictive factor for amputation and mortality in patients hospitalized for peripheral artery disease. Eur J Vasc Endovasc Surg2014; 48(2): 202–207.
7.
OshinOATorellaF. Low hemoglobin concentration is associated with poor outcome after peripheral arterial surgery. Vasc Endovascular Surg2013; 47(6): 449–453.
8.
PerezPEstebanECaballeroPEJ, et al.Anemia and outcome in outpatients with peripheral artery disease. Angiology2015; 67(5): 484–489.
9.
HusseinAAwadMSSabraAM, et al.Anemia is a novel predictor for clinical ISR following PCI. Egypt Heart J2021; 73(1): 40.
10.
HuHWangSTangG, et al.Impact of anemia on in-stent restenosis after percutaneous coronary intervention. BMC Cardiovasc Disord2021; 21(1): 548.
11.
WHO. Nutritional anaemias: report of a WHO scientific group. World Health Organ Tech Rep Ser. 1968;405:5–37.
12.
SchmidtAPiorkowskiMGörnerH, et al.Drug-coated balloons for complex femoropopliteal lesions: 2-year results of a real-world registry. JACC Cardiovasc Interv2016; 9(7): 715–724.
13.
LüdersFEngelbertzCMeyborgM, et al.Acute and chronic anemia and short- and long-term outcome of patients with peripheral arterial disease and critical limb ischemia. Eur J Intern Med2016; 31: 62–67.
14.
HosseiniSKHAnsariMJATokaldanyML, et al.Association between preprocedural hemoglobin level and 1-year outcome of elective percutaneous coronary intervention. J Cardiovasc Med (Hagerstown)2014; 15(4): 331–335.
15.
MartinDMBoyleFJ. Drug-eluting stents for coronary artery disease: a review. Med Eng Phys2011; 33(2): 148–163.
16.
BønaaKHMannsverkJWisethR, et al.Drug-eluting or bare-metal stents for coronary artery disease. N Engl J Med2016; 375(13): 1242–1252.
17.
StolzenburgNBreinlJBienekS, et al.Paclitaxel-coated balloons: investigation of drug transfer in healthy and atherosclerotic arteries – first experimental results in rabbits at low inflation pressure. Cardiovasc Drugs Ther2016; 30(3): 263–270.
18.
ChowdhuryMMSinghKAlbaghdadiM, et al.Paclitaxel drug-coated balloon angioplasty suppresses progression and inflammation of experimental atherosclerosis in rabbits. JACC Basic Transl Sci2020; 5(7): 685–695.
19.
HumarRKieferFNBernsH, et al.Hypoxia enhances vascular cell proliferation and angiogenesis in vitro via rapamycin (mTOR)-dependent signaling. FASEB J2002; 16(8): 771–780.
20.
BrasenJHKivelaARoserK, et al.Angiogenesis, vascular endothelial growth factor and platelet-derived growth factor-BB expression, iron deposition, and oxidation-specific epitopes in stented human coronary arteries. Arterioscler Thromb Vasc Biol2001; 21(11): 1720–1726.
21.
HytonenJPTaavitsainenJLaitinenJTT, et al.Local adventitial anti-angiogenic gene therapy reduces growth of vasa-vasorum and in-stent restenosis in WHHL rabbits. J Mol Cel Cardiol2018; 121: 145–154.
22.
GiustinoGKirtaneAJBaberU, et al.Impact of anemia on platelet reactivity and ischemic and bleeding risk: from the assessment of dual antiplatelet therapy with drug-eluting stents study. Am J Cardiol2016; 117(12): 1877–1883.
23.
ShahPK. Inflammation, infection and atherosclerosis. Trends Cardiovasc Med2019; 29(8): 468–472.
24.
InoueTCroceKMorookaT, et al.Vascular inflammation and repair: implications for re-endothelialization, restenosis, and stent thrombosis. JACC Cardiovasc Interv2011; 4(10): 1057–1066.
25.
LanserLFuchsDScharnaglH, et al.Anemia of chronic disease in patients with cardiovascular disease. Front Cardiovasc Med2021; 8: 666638.
26.
JakubiakGKPawlasNCieślarG, et al.Pathogenesis and clinical significance of in-stent restenosis in patients with diabetes. Int J Environ Res Public Health2021; 18(22): 11970.
27.
SonmezAYilmazMISaglamM, et al.The relationship between hemoglobin levels and endothelial functions in diabetes mellitus. Clin J Am Soc Nephrol2010; 5(1): 45–50.
28.
GengNSuGWangS, et al.High red blood cell distribution width is closely associated with in-stent restenosis in patients with unstable angina pectoris. BMC Cardiovasc Disord2019; 19(1): 175.
29.
TheumaFNickinsonATOCullenS, et al.The impact of anemia on one-year amputation-free survival in patients undergoing revascularization for chronic limb-threatening ischemia: a retrospective cohort study. Ann Vasc Surg2021; S0890-5096(21): 00666–X.
