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[Long-term outcome of infra-inguinal endovascular surgery for critical ischemia]
J Marzelle1, R Raffoul, T Mekouar
1Clinique de la Défense, Nanterre, France.
Insights
Endovascular surgery offers a viable option for critical limb ischemia, demonstrating good limb salvage rates. Factors like occlusion and atherectomy significantly impact long-term patency in these patients.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Interventions
Background:
- Critical limb ischemia (CLI) poses a significant challenge, often necessitating revascularization.
- Endovascular surgery presents an alternative to traditional open surgical approaches for CLI.
- Evaluating the long-term outcomes of endovascular interventions in CLI is crucial for treatment planning.
Purpose of the Study:
- To assess the efficacy and outcomes of endovascular surgery in a cohort of 186 patients with critical limb ischemia.
- To identify factors influencing the patency and limb salvage rates following endovascular treatment for CLI.
Main Methods:
- A retrospective analysis of 186 patients (100 women, 86 men; mean age 74.5 years) undergoing endovascular procedures for CLI.
- Treatment targeted stenosis or occlusion in the superficial femoral, popliteal, or tibial arteries.
- Data collected included technical success, in-hospital mortality, cumulative patency, and limb salvage rates.
Main Results:
- Technical success was achieved in 81% of cases, with an in-hospital mortality of 6.5%.
- Cumulative patency rates were 61% at 12 months and 52% at 48 months.
- Limb salvage rates were 87% at 12 months and 82% at 48 months, with occlusion and atherectomy use being significant predictors of patency.
Conclusions:
- Endovascular surgery provides a fair long-term limb salvage rate for patients with critical limb ischemia.
- Despite risks of technical failure and restenosis, this approach is a valuable option.
- Occlusion status and the use of atherectomy are key determinants of successful endovascular treatment outcomes.
Study Aim:
Endovascular surgery can be proposed as an alternative to infrainguinal conventional surgery in critical ischemia. The aim of this study was to report the latest results of our series of 186 patients.
Materials And Methods:
One hundred and eighty-six patients (100 women and 86 men; mean age 74.5 +/- 13 years) were treated for pain during rest (31.5%), gangrene (58%), or ischemic ulcer (10.5%). The lesions were unilateral (n = 172) or bilateral (n = 14). Two hundred eighty-seven target lesions were treated: for stenosis (n = 168) or occlusion (n = 119): of superficial femoral artery (31.7%), popliteal artery (40%) or tibial arteries (28.3%).
Results:
Technical success was achieved in 81% (15% amputations). The in-hospital mortality rate was 6.5%. The cumulative patency rate was 61 +/- 3% at 12 months, and 52 +/- 6% at 48 months. The limb salvage rate was 87 +/- 3% at 12 months and 82 +/- 4% at 48 months. Thirteen potential factors of patency were analyzed: the only predictive factors affecting patency were occlusion versus stenosis, and the use of atherectomy (Log rank test: P < 0.001 and P < 0.0001).
Conclusion:
Despite a risk of technical failure and of mid-term restenosis, endovascular surgery for critical ischemia provides a fair long-term limb salvage rate.