Safety of endovascular treatment in high-cardiac-risk patients with limb-threatening ischemia

Area of Science:

• Cardiovascular Surgery
• Vascular Medicine
• Interventional Cardiology

Background:

• Advanced peripheral vascular disease (PVD) often coexists with coronary artery disease (CAD), increasing perioperative cardiac risks during vascular surgery.
• Approximately 60% of PVD patients have concomitant CAD, posing significant challenges for surgical revascularization.
• Assessing and mitigating cardiac risk is crucial for managing patients with PVD requiring revascularization.

Purpose of the Study:

• To validate the hypothesis that endovascular revascularization is a safer option for high-cardiac-risk patients with PVD.
• To compare perioperative and long-term cardiac complication rates between endovascular and open surgical revascularization in high-risk PVD patients.

Main Methods:

• A cohort of 114 patients with PVD underwent pre-operative cardiac risk assessment using clinical evaluation, echocardiography, and dipyridamole stress testing.
• High-cardiac-risk patients were identified based on clinical scores, low ejection fraction, or positive stress tests.
• Patients were divided into two groups: endovascular treatment (Group A) and open bypass surgery (Group B), and monitored for cardiac events during surgery, post-operatively, and for 18 months post-discharge.

Main Results:

• 42% of patients were classified as high-cardiac-risk. Among these, 77% (Group A) received endovascular treatment, and 23% (Group B) underwent open surgery.
• Postoperative cardiac complications were significantly lower in Group A (16%) compared to Group B (45%) (p < 0.05), with fewer early deaths.
• Late cardiac event rates were similar between groups (51% vs. 44%), but limb salvage rates were comparable (95% vs. 100%).

Conclusions:

• Endovascular procedures offer a significantly lower incidence of perioperative cardiac complications for high-cardiac-risk patients with limb-threatening ischemia due to PVD.
• Open bypass surgery in this high-risk population is associated with substantially higher perioperative cardiac morbidity.
• The study underscores the high prevalence of CAD in PVD patients and the benefit of less invasive endovascular approaches for managing cardiac risk.