Endovascular Re-Intervention for Recurrent Lower Limb Ischemia After Previous Endovascular Intervention

Background Redo endovascular interventions are increasingly employed to address recurrent lower limb ischemia following prior successful procedures. Despite their minimally invasive nature and flexibility, there is limited data on their midterm effectiveness and safety. Objective To evaluate the effectiveness and outcomes of endovascular re-intervention in managing recurrent lower limb ischemia after previous procedures. Patients and Methods This study included 40 patients with recurrent lower limb ischemia, managed at Shebin Elkoom Teaching Hospital between 2023 and 2024. Patients had previously undergone successful endovascular interventions at least 30 days before recurrence and were treated with angioplasty alone or in combination with stenting. Outcomes, including patency rates, limb salvage, and clinical improvement, were assessed over a six-month follow-up period. Results The study included 40 patients (mean age: 63.6 ± 4.2 years; 70% male). Initial presentations included rest pain (75%), claudication (20%), and minor tissue loss (5%). Recurrence was categorized as claudication (40%), rest pain (50%), or tissue loss (10%). The most common lesions were SFA re-stenosis (35%) and re-occlusion (20%). Angioplasty alone was performed in 45% of cases, and stenting in 55%, with retrograde access used in 5 patients for complex lesions. Early complications included groin hematomas (15%), pseudo-aneurysms (10%), and contrast-induced nephropathy (5%), with no mortality. At six months, the primary patency rate was 75%, assisted patency 90%, and secondary patency 85%. Four patients underwent trans-metatarsal amputations, and two required below-knee amputations. Limb salvage was achieved in 94% of cases, with significant symptom improvement reported in most patients. Conclusion Redo endovascular interventions are a safe and effective option for managing recurrent lower limb ischemia, offering high patency rates, significant limb salvage, and clinical improvements over the midterm. These findings support their continued use in recurrent ischemia management.