Outcomes of infrainguinal revascularizations with endovascular first strategy in critical limb ischemia
Sjoerd Jens1, Anne P Conijn, Franceline A Frans
1Department of Radiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands, s.jens@amc.uva.nl.
Insights
Infrainguinal revascularization for critical limb ischemia (CLI) showed improved quality of life and functional status. Endovascular treatment first in high-risk patients yielded comparable or better outcomes than surgery.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Critical Limb Ischemia (CLI) Management
Background:
- Critical limb ischemia (CLI) poses significant challenges in patient management.
- Treatment strategies for CLI often involve complex decisions, especially in high-risk individuals.
Purpose of the Study:
- To evaluate the outcomes of infrainguinal revascularization in CLI patients.
- To assess the effectiveness of a strategy prioritizing endovascular intervention for specific high-risk patient groups.
Main Methods:
- Prospective observational cohort study (May 2007-May 2010) of 113 CLI patients.
- Treatment selection (endovascular vs. surgical) guided by patient condition, anatomy, and multidisciplinary team (MDT) input.
- Quality of life (VascuQol) and functional status (AMC Linear Disability Score) assessed at 6 and 12 months.
Main Results:
- Both endovascular and surgical revascularization improved quality of life (VascuQol scores) significantly at 6 and 12 months.
- Overall functional status improved at 12 months post-intervention.
- Surgical subgroup showed significant functional status improvement at 6 and 12 months; endovascular subgroup did not show significant functional improvement.
Conclusions:
- A strategy prioritizing endovascular treatment for high-risk CLI patients (poor condition, unfavorable anatomy, elderly, no venous material) demonstrates comparable or superior results to traditional approaches.
- Implementation of a multidisciplinary team (MDT) approach is recommended to optimize patient outcomes in CLI management.
- Further discussion among vascular groups is encouraged to consider adopting an endovascular-first strategy for CLI patients.
Purpose:
This study was designed to study the outcome of infrainguinal revascularization in patients with critical limb ischemia (CLI) in an institution with a preference towards endovascular intervention first in patients with poor condition, unfavourable anatomy for surgery, no venous material for bypass, and old age.
Methods:
A prospective, observational cohort study was conducted between May 2007 and May 2010 in patients presenting with CLI. At baseline, the optimal treatment was selected, i.e., endovascular or surgical treatment. In case of uncertainty about the preferred treatment, a multidisciplinary team (MDT) was consulted. Primary endpoints were quality of life and functional status 6 and 12 months after initial intervention, assessed by the VascuQol and AMC Linear Disability Score questionnaires, respectively.
Results:
In total, 113 patients were included; 86 had an endovascular intervention and 27 had surgery. During follow-up, 41 % underwent an additional ipsilateral revascularisation procedure. For the total population, and endovascular and surgery subgroups, the VascuQol sum scores improved after 6 and 12 months (p < 0.01 for all outcomes) compared with baseline. The functional status improved (p = 0.043) after 12 months compared with baseline for the total population. Functional status of the surgery subgroup improved significantly after 6 (p = 0.031) and 12 (p = 0.044) months, but not that of the endovascular subgroup.
Conclusions:
Overall, the strategy of performing endovascular treatment first in patients with poor condition, unfavourable anatomy for surgery, no venous material for bypass, and old age has comparable or even slightly better results compared with the BASIL trial and other cohort studies. All vascular groups should discuss whether their treatment strategy should be directed at treating CLI patients preferably endovascular first and consider implementing an MDT to optimize patient outcomes.
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