Endovascular Versus Open Revascularization for Peripheral Arterial Disease

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Public Health

Background:

• Optimal revascularization strategy for symptomatic lower extremity peripheral arterial disease (PAD) remains undetermined.
• Symptomatic PAD significantly impacts patient morbidity and mortality.

Purpose of the Study:

• To compare the long-term efficacy of endovascular versus open revascularization in patients with symptomatic peripheral arterial disease (PAD).

Main Methods:

• Utilized propensity-score matched cohorts of Medicare beneficiaries diagnosed with PAD between 2006 and 2009.
• Evaluated amputation-free survival, overall survival, and rates of subsequent vascular interventions.

Main Results:

• Endovascular repair demonstrated improved amputation-free survival at 30 days and persisted long-term (4 years).
• Patients undergoing endovascular procedures had a 16% reduced risk of amputation or death compared to open procedures.
• A modest increase in subsequent interventions was observed with endovascular repair, remaining stable over 4 years.

Conclusions:

• Endovascular revascularization is associated with superior long-term amputation-free survival in PAD patients.
• The benefits of endovascular repair are particularly notable in patients with comorbid congestive heart failure or ischemic heart disease.
• While endovascular approaches require a slightly higher rate of repeat interventions, they offer a favorable risk-benefit profile for long-term outcomes.