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Assessing Therapeutic Angiogenesis in a Murine Model of Hindlimb Ischemia
Published on: June 8, 2019
Do current outcomes justify more liberal use of revascularization for vasculogenic claudication? A single center
Spence M Taylor1, Corey A Kalbaugh, Matthew G Healy
1Academic Department of Surgery, Greenville Hospital System University Medical Center, Greenville, SC 29605, USA.
Insights
Contemporary treatments for vasculogenic claudication, primarily endovascular procedures, show safe and effective outcomes. These findings support broader revascularization for patients experiencing claudication symptoms.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Peripheral Artery Disease
Background:
- Current treatment guidelines for vasculogenic claudication are being re-evaluated.
- The study examines contemporary surgical intervention outcomes.
Purpose of the Study:
- To reconsider current treatment guidelines for vasculogenic claudication.
- To assess the results of surgical interventions for this condition.
Main Methods:
- Retrospective review of 1,000 limbs in 669 patients with medically refractory vasculogenic claudication.
- Prospective follow-up measuring complication rates, patency, limb salvage, ambulatory status, independence, survival, and symptom recurrence.
Main Results:
- Endovascular therapy (64.3%) and open surgery (35.7%) were used for aortoiliac (70.1%) and infrainguinal (29.9%) disease.
- 30-day complication rate was 7.5% with no significant difference between treatment types.
- 1- and 5-year primary patency rates were 87.7%/70.8%, secondary patency 97.8%/93.9%, limb salvage 100%/98.8%, and survival 95.4%/76.9%.
Conclusions:
- Contemporary treatment for vasculogenic claudication is safe and effective, with a trend towards endovascular approaches.
- Data support increased use of revascularization for claudication.
- Current nonoperative guidelines may be outdated.
Background:
The purpose of this study was to reconsider current recommended treatment guidelines for vasculogenic claudication by examining the contemporary results of surgical intervention.
Study Design:
We performed a retrospective review of 1,000 consecutive limbs in 669 patients treated for medically refractory vasculogenic claudication and prospectively followed. Outcomes measured included procedural complication rates, reconstruction patency, limb salvage, maintenance of ambulatory status, maintenance of independent living status, survival, symptom resolution, and symptom recurrence.
Results:
Of the 1,000 limbs treated, endovascular therapy was used in 64.3% and open surgery in 35.7% of patients; aortoiliac occlusive disease was treated in 70.1% and infrainguinal disease in 29.9% of patients. The overall 30-day periprocedural complication rate was 7.5%, with no notable difference in complication rates when comparing types of treatment or levels of disease. Overall reconstruction primary patency rates were 87.7% and 70.8%; secondary patencies were 97.8% and 93.9%; limb salvage, 100% and 98.8%; and survivals, 95.4% and 76.9%, at 1 and 5 years, respectively. More than 96% of patients maintained independence and ambulatory ability at 5 years. Overall symptom resolution occurred in 78.8%, and symptom recurrence occurred in 18.1% of limbs treated, with slightly higher resolution and recurrence noted in patients treated with endovascular therapy.
Conclusions:
Contemporary treatment of vasculogenic claudication is safe, effective, and predominantly endovascular. These data support a more liberal use of revascularization for patients with claudication and suggest that current nonoperative treatment guidelines may be based more on surgical dogma than on achievable outcomes.
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