Document Detail


Outcomes of reinterventions after subintimal angioplasty.
MedLine Citation:
PMID:  20541345     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: With increased use of subintimal angioplasty (SIA), the role of reintervention after recurrence is currently unknown. To more clearly define the technical feasibility, patency, and clinical outcomes of reinterventions after SIA, we reviewed our cumulative experience.
METHODS: A retrospective review of patient information (including demographics, indications, procedures, noninvasive arterial studies, and postprocedural events) was performed on those patients undergoing reintervention after a primary subintimal angioplasty in the infrainguinal vessels. Continuous and noncontinuous data were compared using the Student t-test and the z test, respectively. Patency was calculated by Kaplan-Meier analysis. Survival curves were compared using log-rank and Wilcoxon testing for univariate analysis and Cox hazard-regression analysis for multivariate analysis.
RESULTS: From December 2002, through July 2006, 495 SIAs were performed for infrainguinal disease in 482 patients. Of this cohort, 121 patients (25%) required 188 consecutive reinterventions. Each patient underwent an average of 1.5 +/- 0.8 (range, 1-7) reinterventions during this study. We analyzed only the outcomes of 124 consecutive, first reinterventions. Mean interval time between primary SIA and the first reintervention was 7.8 +/- 6.8 months (range, 1 day-31 months). Indications for reintervention were clinical only (recurrence of symptoms or worsening exam), diagnostics only (recurrence based on peripheral vascular lab studies), or both in 18%, 25%, and 52% of patients, respectively. Technical success was achieved in 94% (n = 117) of the procedures. Repeat SIA technique was utilized in 68% (n = 84) of reinterventions and other endovascular therapies (32%; n = 40), of which the majority were transluminal angioplasty, for the remaining reinterventions. Mean follow-up was 8.6 months (range, 0-34 months). The patency rate at 1 year for the first reintervention was 33%. One-year patency rates for reinterventions performed within 3 months of the primary SIA were worse than those performed after 3 months (22% vs 34%; P = .04). In addition, patients treated for claudication had better 1-year patency than those treated for critical limb ischemia (37% vs 27%; P = .03). Other demographic or procedural variables did not significantly affect patency. In patients with critical limb ischemia (CLI), limb salvage rate at 1 year was 71%.
CONCLUSION: Endovascular reintervention after SIA is a safe and technically feasible procedure for recurrences and offers good limb salvage rate. Early reinterventions performed within 3 months of the original SIA portend a worse outcome. In addition, reinterventions are less durable in patients with CLI compared with claudication. Finally, by identifying a recurrent stenosis instead of an occlusion, close surveillance may contribute to improved overall outcome.
Authors:
Gregory C Schmieder; Albert I Richardson; Eric C Scott; Gordon K Stokes; George H Meier; Jean M Panneton
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2010-06-11
Journal Detail:
Title:  Journal of vascular surgery     Volume:  52     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-30     Completed Date:  2010-08-31     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:  375-82     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2010 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, Va, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Angioplasty / methods*
Arterial Occlusive Diseases / complications,  physiopathology,  therapy*
Constriction, Pathologic
Feasibility Studies
Female
Humans
Intermittent Claudication / etiology,  physiopathology,  therapy*
Ischemia / etiology,  physiopathology,  therapy*
Kaplan-Meier Estimate
Limb Salvage
Male
Middle Aged
Proportional Hazards Models
Recurrence
Retreatment
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Vascular Patency
Vascular Surgical Procedures
Virginia

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