Author(s): DeRubertis BG, Faries PL, McKinsey JF, Chaer RA, Pierce M,
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Abstract OBJECTIVES: Catheter-based revascularization has emerged as an alternative to surgical bypass for lower extremity vascular disease and is a frequently used tool in the armamentarium of the vascular surgeon. In this study we report contemporary outcomes of 1000 percutaneous infra-inguinal interventions performed by a single vascular surgery division. METHODS: We evaluated a prospectively maintained database of 1000 consecutive percutaneous infra-inguinal interventions between 2001 and 2006 performed for claudication (46.3\%) or limb-threatening ischemia (52.7\%; rest pain in 27.7\% and tissue loss in 72.3\%). Treatments included angioplasty with or without stenting, laser angioplasty, and atherectomy of the femoral, popliteal, and tibial vessels. RESULTS: Mean age was 71.4 years and 57.3\% were male; comorbidities included hypertension (84\%), coronary artery disease (51\%), diabetes (58\%), tobacco use (52\%), and chronic renal insufficiency (39\%). Overall 30-day mortality was 0.5\%. Two-year primary and secondary patencies and rate of amputation were 62.4\%, 79.3\%, and 0.5\%, respectively, for patients with claudication. Two-year primary and secondary patencies and limb salvage rates were 37.4\%, 55.4\%, and 79.3\% for patients with limb-threatening ischemia. By multivariable Cox PH modeling, limb-threat as procedural indication (P < 0.0001), diabetes (P = 0.003), hypercholesterolemia (P = 0.001), coronary artery disease (P = 0.047), and Transatlantic Inter-Society Consensus D lesion complexity (P = 0.050) were independent predictors of recurrent disease. For patients that developed recurrent disease, 7.5\% required no further intervention, 60.3\% underwent successful percutaneous reintervention, 11.7\% underwent bypass and 20.5\% underwent amputation. Patency rates were identical for the initial procedure and subsequent reinterventions (P = 0.97). CONCLUSION: Percutaneous therapy for peripheral vascular disease is associated with minimal mortality and can achieve 2-year secondary patency rates of nearly 80\% in patients with claudication. Although patency is diminished in patients with limb-threat, limb-salvage rates remain reasonable at close to 80\% at 2 years. Percutaneous infra-inguinal revascularization carries a low risk of morbidity and mortality, and should be considered first-line therapy in patients with chronic lower extremity ischemia.
This article was published in Ann Surg
and referenced in JBR Journal of Clinical Diagnosis and Research