Open versus endovascular intervention for critical limb ischemia: a population-based study

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Public Health Outcomes

Background:

• Critical limb ischemia (CLI) is often treated with endovascular techniques.
• Assessing the impact of endovascular therapy on CLI and amputation rates in South Carolina over a decade is crucial.

Purpose of the Study:

• To evaluate the effectiveness of endovascular therapy in managing CLI.
• To compare amputation rates before and after the widespread adoption of endovascular procedures for CLI.

Main Methods:

• Retrospective analysis of CLI treatment outcomes in South Carolina.
• Comparison of patient data from 1996 (pre-endovascular era) and 2005 (endovascular era).
• Utilized ICD-9 codes to identify revascularization, amputation, and secondary procedures.

Main Results:

• Limb revascularization procedures increased by 33%, with a shift from 26% endovascular in 1996 to 51% in 2005.
• Amputation rates at 1 and 3 years post-revascularization showed no significant difference between the two eras (34% vs. 34% at 1 year; 43% vs. 40% at 3 years).
• The rate of secondary revascularization within the same year significantly increased from 8% in 1996 to 19% in 2005 (p < 0.001).

Conclusions:

• Despite an increase in endovascular procedures for CLI, overall amputation rates have not improved.
• The adoption of endovascular therapy has led to a higher requirement for repeat procedures to maintain limb salvage.
• Current endovascular approaches may necessitate more interventions to achieve outcomes comparable to traditional open surgery.