Target outflow vessel compromise after failed endovascular interventions for infra-inguinal arterial disease
Mohammed Elkassaby1, Surbhi Chawla2, Mary-Paula Colgan2
1Department of Vascular Surgery, St. James's Hospital, Dublin, Ireland; Department of Vascular Surgery, University Hospital Waterford, Ireland; Department of vascular surgery, Mansoura University, Egypt.
Insights
An endovascular-first strategy is safe for infra-inguinal arterial disease. Failed angioplasties rarely damage outflow vessels, preserving future treatment options for peripheral arterial disease (PAD).
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Peripheral Arterial Disease Management
Background:
- The optimal strategy for infra-inguinal arterial disease remains debated, with concerns about outflow vessel damage from failed endovascular procedures.
- Existing research, including BEST CLI and BASIL II trials, has not definitively settled the bypass-first versus endovascular-first debate.
Purpose of the Study:
- To evaluate the extent of damage to target outflow vessels following failed angioplasties in patients with infra-inguinal arterial disease.
- To assess the safety and effectiveness of an endovascular-first approach by examining outcomes after failed angioplasties.
Main Methods:
- Retrospective analysis of 724 infra-inguinal angioplasties over 5 years, focusing on 101 failed episodes.
- Primary endpoint: presence and extent of target outflow vessel damage.
- Secondary endpoints: complications, mortality, re-intervention types, and success rates.
Main Results:
- In 78.2% of failed angioplasties, no damage to target outflow vessels was observed.
- Redo angioplasty was successful in 42% of cases (p=0.069).
- Open surgical bypass (OSB) achieved a 91% success rate (p=0.009) for subsequent interventions.
Conclusions:
- An endovascular-first strategy is safe and effective for treating peripheral arterial disease (PAD).
- Concerns regarding compromised future treatment options after failed angioplasty are not substantiated by this study.
- The data support the viability of endovascular approaches without jeopardizing subsequent surgical interventions.
Introduction:
Even after two major RCTs, the BEST CLI and BASIL II, the debate about best strategy to address infra-inguinal arterial disease continues. Damage of distal outflow vessels after failed angioplasties and compromise to future options remains the main concern of bypass-first strategy advocates versus endovascular enthusiasts.
Objectives:
To assess the degree of target outflow vessels damage after failed angioplasties.
Methods:
This was a retrospective study looking at all episodes of failed angioplasties for infra-inguinal arterial disease over 5 years. Primary end points were the presence and extent of damage to target outflow vessels. Secondary endpoints included complications, mortality, re-intervention types, and their success rates.
Results:
There were 101 failed episodes out of 724 infra-inguinal angioplasties (primary success 86 %). The mean age of failed angioplasty cases was 73 (+- 10.5) years. There was no damage to target outflow vessels after failed angioplasty in 78.2 % of the episodes. Redo angioplasty was attempted in 43 %, with 42 % success rate (p-value 0.069), while Open surgical bypass "OSB" was performed for 21 % of the cases with a success rate of 91 % (p-value 0.009) CONCLUSION: An endovascular-first strategy for treatment of peripheral arterial disease "PAD is safe and effective. The concern for compromised future options is not justified.
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