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Outcome of infrainguinal endovascular revascularization procedures for limb-threatening ischemia
J Marzelle1, J M Fichelle, F Cormier
1Unit of Vascular Surgery, Clinique de la Défense, Nanterre, France.
Insights
Infrainguinal endovascular revascularization offers satisfactory limb salvage rates, particularly for elderly patients. Poor runoff and occlusive lesions significantly increase initial failure risk in treating critical limb ischemia.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Peripheral Artery Disease
Background:
- Limb-threatening ischemia requires effective revascularization strategies.
- Endovascular techniques offer an alternative to traditional bypass surgery.
Purpose of the Study:
- To evaluate the outcomes of infrainguinal endovascular revascularization in patients with critical limb ischemia.
- To identify risk factors for initial failure and restenosis.
Main Methods:
- Retrospective analysis of 96 infrainguinal endovascular procedures in 86 patients.
- Assessment of techniques including transluminal angioplasty, laser, Rotablator, and thrombectomy.
- Statistical analysis (ANOVA) to determine risk factors for failure and restenosis.
Main Results:
- Initial failure was significantly correlated with poor runoff and occlusive lesions.
- Restenosis was significantly correlated with male sex and older age.
- Actuarial 1-year primary patency, secondary patency, and limb salvage rates were 47%, 67%, and 81% respectively.
Conclusions:
- Infrainguinal endovascular revascularization provides acceptable limb salvage rates.
- Risk factors for failure and restenosis should be considered in patient selection and management.
- Endovascular treatment is a viable option for elderly patients with contraindications to bypass surgery.
Abstract:
This report describes the results of 96 infrainguinal endovascular revascularization procedures performed in 86 patients with limb-threatening ischemia over a 3-year period. There were 41 women and 45 men (mean age 72.9 +/- 11.9 years) including 47 patients (51.1%) with diabetes and 13 (15.1%) with renal insufficiency. All patients had severe ischemia characterized by rest pain (18.8%), ulceration (12.5%), or gangrene (68.8%). Twelve procedures were carried out in association with conventional surgical reconstruction and in eight patients with mixed ulcers a venous procedure was performed during the same session. A total of 143 arterial lesions were treated including 61 occlusions (mean length 5.9 +/- 3.5 cm) and 82 stenoses (mean length 4.6 +/- 3 cm). The following techniques were used: transluminal angioplasty in 99 cases, laser in five cases, Rotablator in 24 cases, and aspiration thrombectomy in 15 cases. Nine patients (10.5%) died in the hospital. Initial failure was observed in 32 patients, of whom 18 underwent subsequent surgical revascularization and 14 required amputation of the extremity within 2 months. Analysis of variance was used to assess the following 12 risk factors for initial failure of endovascular revascularization: sex, age, diabetes, renal insufficiency, associated surgery, treatment of multiple lesions, artery treated, type of lesion, length of lesion, quality of runoff, use of an atherotome, and stent placement. Results showed a significant correlation between initial failure and both quality of runoff (12.9% in patients with two or more patent leg arteries vs. 36.5% in patients with one or fewer patent leg arteries; p < 0.05) and type of lesion (14.5% for stenosis vs. 45.9% for occlusion). Mean follow-up was 9.98 +/- 9.9 months and 4.7% of patients were lost. Restenosis was observed during follow-up of 16 of the 74 initially successful procedures. ANOVA was used to assess the same 12 risk factors for restenosis. Results showed a significant correlation between restenosis and both sex (10.8% in women vs. 32.4% in men; p < 0.05) and age (8% for patients > 80 years of age vs. 28.6% for patients < 80 years; p < 0.05). Primary patency, secondary patency and limb salvage rates calculated according to the actuarial method were 65%, 75%, and 84%, respectively, at 6 months and 47%, 67%, and 81%, respectively, at 1 year. Limb salvage rates for the endoluminal techniques used in this study were satisfactory, especially in elderly patients with either segmental lesions or contraindications for distal bypass.