Document Detail


Changing pattern of surgical revascularization for critical limb ischemia over 12 years: endovascular vs. open bypass surgery.
MedLine Citation:
PMID:  16890859     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: This study is a review and evaluation of our 12-year experience of revascularization for critical limb ischemia (CLI) with angioplasty/stenting and bypass surgery to identify specific trends of procedure volume and outcomes in this particular group.
METHODS: Endovascular and open bypass procedures done for CLI by a single surgeon between 1993 and 2004 were evaluated retrospectively. Thrombolysis and thrombectomy procedures done as the only revascularization procedure were excluded from analysis. The data were divided into three groups by time periods: the first period, 1993 to 1996; the second period, 1997 to 2000; and the third period, 2001 to 2004. Outcomes were defined according to the reporting standards of the Society for Vascular Surgery/International Society for Cardiovascular Surgery. The study included 416 procedures done in 237 limbs in 192 patients. The mean follow-up was 23 months (range, 1 to 122 months).
RESULTS: Primary revascularization procedures for CLI were angioplasty in 153 limbs (65%) and bypass surgery in 84 (35%). Subsequent procedures were angioplasty in 102 limbs (57%) and open surgery (bypass and/or patch angioplasty) in 77 limbs (43%). The rates for technical and clinical success and complications in the entire group were 99%, 95%, and 4%, respectively. One patient died perioperatively (0.5%). Among the three periods, TransAtlantic Inter-Society Consensus lesion types were significantly more severe in patients in the first period (P < .05). Additionally, the complication rate was significantly higher and the mean hospital stay was significantly longer in the first period compared with the second and third periods (P < .05). Furthermore, between the first and third periods, the number of endovascular revascularization procedures done as primary and secondary procedures significantly increased from 15 to 84 (+460%) and from 13 to 57 (+340%), whereas the number of open surgical procedures done as primary and secondary procedures decreased from 39 to 20 (-49%) and from 35 to 18 (-49%), respectively (P < .0001). The assisted primary patency rates in the third period were significantly higher than those in the first and second periods (P = .012); otherwise, the long-term outcomes among the three periods were not statistically different. Multivariate analysis revealed that, while controlling for other factors, the third period showed improvement in the primary patency (P = .032) and assisted primary patency (P = .051), and the bypass group showed improvement in the primary patency (P = .008).
CONCLUSIONS: In our experience, open surgical procedures for the treatment of CLI have been largely replaced by angioplasty procedures without compromising outcomes. Angioplasty is a feasible, safe, and effective procedure and can be the procedure of choice for the primary and secondary treatment of CLI. Open surgical procedures can be reserved for lesions technically unsuitable for endovascular procedures and patients who do not demonstrate clinical improvement after angioplasty.
Authors:
Toshifumi Kudo; Fiona A Chandra; Woo-Hyung Kwun; Bradley T Haas; Samuel S Ahn
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  44     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2006 Aug 
Date Detail:
Created Date:  2006-08-07     Completed Date:  2006-09-18     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  304-13     Citation Subset:  IM    
Affiliation:
Gonda (Goldschmied) Vascular Center, University of California at Los Angeles, Los Angeles, CA 90024, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty / trends*
Blood Vessel Prosthesis Implantation / trends*
Female
Humans
Ischemia / surgery*,  therapy*
Lower Extremity / blood supply*
Male
Patient Selection
Peripheral Vascular Diseases / surgery*,  therapy*
Postoperative Complications*
Reoperation
Retrospective Studies
Stents
Survival Analysis
Tibial Arteries*
Time Factors
Vascular Patency

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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