Invasive treatment for infrainguinal claudication has satisfactory 1 year outcome in three out of four patients: a
H Lindgren1, A Gottsäter2, P Qvarfordt3
1Faculty of Medicine, Lund University, Lund, Sweden; Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden.
Insights
Invasive treatments for infrainguinal intermittent claudication (IC) in Sweden showed a 73.2% improvement rate at one year. However, a significant portion of patients experienced no change or worsening, highlighting a need for further research into optimal treatment strategies.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Public Health
Background:
- Conservative treatment is recommended for infrainguinal intermittent claudication (IC), yet invasive procedures are frequently employed.
- This study evaluates the outcomes of invasive treatments for IC in Sweden.
Purpose of the Study:
- To determine the incidence and 1-year results of all invasive treatments for infrainguinal IC in Sweden during 2009.
- To compare the outcomes of open surgery, endovascular treatment, and hybrid procedures for IC.
Main Methods:
- A one-year follow-up of 775 patients who underwent 843 invasive infrainguinal procedures for IC in Sweden in 2009, utilizing the Swedish Vascular Registry (Swedvasc).
- Procedures included open surgery (37%), endovascular treatment (58%), and hybrid treatment (5%).
- Clinical outcomes were assessed based on patient-reported leg function, amputations, and mortality at one year.
Main Results:
- Overall improvement at 1 year was 73.2% (225/290 open surgery, 320/447 endovascular, 22/38 hybrid).
- No significant difference in outcomes was observed between open surgery and endovascular treatment (p = .350).
- Hybrid treatment yielded significantly worse results (p = .046). Amputations occurred in 1.7% (open), 0.6% (endovascular), and 7.5% (hybrid) of limbs. Mortality was 3.4% (open) and 2.7% (endovascular).
Conclusions:
- Invasive treatments for infrainguinal IC resulted in a 73.2% improvement rate at one year.
- Patients with unchanged or deteriorated clinical states represent a significant challenge.
- Further research is warranted to ascertain the appropriateness of invasive treatments for infrainguinal IC.
Objectives:
In spite of recommendations advocating conservative best medical treatment, many patients with infrainguinal intermittent claudication (IC) are treated by invasive open and endovascular methods. This study aims to evaluate the incidence and 1-year results of all such treatments during 2009 in Sweden.
Methods:
The design was a one-year follow-up through the Swedish Vascular Registry (Swedvasc) of all 775 patients from the Swedish population of 10 million inhabitants in whom 843 invasive infrainguinal procedures (796 index procedures and 47 secondary procedures) were performed for IC in 2009. Index procedures were open surgery in 290 (37%) patients, bilateral in nine cases, giving a total of 299 limbs, endovascular treatment in 447 (58%) patients, bilateral in 10, giving a total of 457 limbs, and hybrid treatment in 38 (5%) patients, bilateral in two cases, giving a total of 40 limbs. Data were analysed both with regard to the number of patients (775) and the number of procedures (843). Clinical outcome was calculated from patient-reported leg function (unchanged, improved, deteriorated) and whether amputation had been necessary or death had occurred. Patent reconstruction at 1 year was also counted as improvement.
Results:
Improvement at 1 year was seen in 567 (73.2%) patients, (225 [77.6%] in the open surgery group, 320 [71.6%] in the endovascular treatment group, and 22 [57.9%] in the hybrid treatment group). No significant difference was found between the open surgery and endovascular treatment groups comprising 737/775 patients (p = .350). Hybrid treatment gave significantly worse results (p = .046). Fifty-seven (7.3%) patients reported unchanged limb function and 32 (4.1%) patients reported deterioration. Within 30 days two patients died and one patient underwent amputation. Within 1 year 10 patients underwent 11 amputations: five (1.7%) in the open surgery group, three (0.6%) in the endovascular treatment group, and two (7.5%) in the hybrid treatment group; one underwent bilateral amputation (p = .07). Twenty-two patients died: 10 (3.4%) in the open surgery group, 12 (2.7%) in the endovascular treatment group and none in the hybrid treatment group (p = .465).
Conclusions:
Reported improvement at 1 year was 73.2% in patients invasively treated for infrainguinal IC. Patients reporting an unchanged or deteriorated clinical state are a considerable clinical challenge. Further studies to determine whether or not invasive treatment of infrainguinal IC is appropriate are justified.
Related Concept Videos
01:27Peripheral Artery Disease III: Interprofessional Care
01:26Varicose Veins II: Diagnostic Studies and Interprofessional Care
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:26Aneurysm III: Interprofessional Care
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation