Outcome for Endovascular and Open Procedures in Infrapopliteal Lesions for Critical Limb Ischemia: Registry Based
F Gentile1, G Lundberg2, R Hultgren2
1Department of Vascular Surgery A2:01, Karolinska University Hospital, 171 76 Stockholm, Sweden; Royal London Hospital, Whitechapel Road, London E1 1BB, UK.
Insights
Endovascular and open procedures for critical limb ischemia (CLI) show similar amputation and survival rates. Open procedures led to more initial complications, highlighting the need to minimize surgical trauma for better wound healing.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Regenerative Medicine
Background:
- Critical limb ischemia (CLI) poses a significant threat to limb salvage and patient survival.
- Infrapopliteal arterial lesions are a common cause of CLI, necessitating effective treatment strategies.
- Diabetic patients represent a vulnerable subgroup with unique challenges in CLI management.
Purpose of the Study:
- To compare the risk factor distribution and outcomes of endovascular versus open procedures for infrapopliteal arterial lesions in CLI patients.
- To specifically evaluate the impact of diabetes on treatment outcomes in this patient population.
- To analyze amputation rates and overall survival following different revascularization approaches.
Main Methods:
- Retrospective analysis of 549 consecutive patients undergoing endovascular or open procedures for infrapopliteal CLI.
- Data sourced from the Swedish Vascular Registry (Swedvasc) between May 2008 and January 2014.
- Primary outcome measures included amputation rate and all-cause mortality; subgroup analysis for diabetic patients was performed.
Main Results:
- No significant demographic differences between endovascular (n=430) and open (n=114) cohorts.
- Open procedures were associated with higher 30-day wound complications (32% vs. 1%), stroke, and myocardial infarction.
- Amputation rates at 30 days were higher with open procedures (7% vs. 2%), but similar at 1 year (10% vs. 7%); mortality was comparable at both time points.
- Diabetic patients undergoing open procedures experienced more complications and higher transfemoral amputation rates at 1 year.
Conclusions:
- Both endovascular and open revascularization demonstrate similar long-term amputation and survival outcomes for infrapopliteal CLI.
- Open procedures are linked to a greater incidence of early postoperative complications, particularly wound-related issues.
- Findings support the continued use of both treatment modalities, emphasizing the importance of minimizing surgical trauma to improve wound healing outcomes.
Objective/Background:
To describe the risk factor distribution and outcome for patients with critical limb ischemia (CLI) due to infrapopliteal arterial lesions treated by endovascular or open procedures, with special consideration of diabetic patients.
Methods:
Data were collected from the Swedish Vascular Registry, Swedvasc, covering all procedures performed on 549 consecutive patients between May 2008 and January 2014 at the Karolinska University Hospital. Diagnosis of ischemic rest pain and/or tissue loss and treatment of infrapopliteal arterial occlusive disease were considered. Analysis was performed on the first procedure during the observation period, "endo" or "open". Amputation rate and death from any cause were recorded as the primary outcome measures. Subgroup analysis was performed on diabetic patients.
Results:
Patient demographics did not differ between the endo (n = 430) and open (n = 114) cohorts. Wound complications requiring treatment within 30 days were more common in patients treated with open procedures (32% vs. 1% for endo; p < .001), as well as stroke and myocardial infarction. Amputation rates were higher at 30 days in the open group (7% vs. 2%; p = .012) but similar at 1 year (10% vs. 7%; p = .206). Mortality was similar at 30 days (p = .400) and 1 year (p = .860). Median survival at the end of the observation period was 43 months for endo and 56 months for open patients (p = .055). Patients with diabetes treated with open procedures had more complications at 30 days and a higher rate of transfemoral amputations at 1 year compared with non-diabetic patients.
Conclusion:
This non-randomized registry based study shows similar outcomes regarding amputation and survival rate in a large group of patients treated for infrapopliteal CLI with endovascular or open procedures, although more post-operative complications were reported in the open group. These findings support the continued use of both treatments while stressing the importance of minimizing surgical trauma to reduce wound complications.
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