|
|
 |
Back to Karmody Posters
Selective Endovascular-first approach for critical limb ischemia carries minimal cost of worsening long-term outcomes
Karan Garg, MD, Patrick A. Kaszubski, BS, Rameen Moridzadeh, BS, Caron B. Rockman, MD, Mark A. Adelman, MD, Thomas S. Maldonado, MD, Frank J. Veith, MD, Firas F. Mussa, MD.
NYU Langone Medical Center, New York, NY, USA.
OBJECTIVES: Treatment failures are common in patients with critical limb ischemia (CLI) and are associated with increased risk of limb loss. Endovascular-first approach is associated with worse overall limb salvage rates presumably because subsequent open bypass options are compromised. To evaluate the effect of endo-first interventions, we examined the late outcomes of patients with failed endovascular attempts undergoing secondary interventions.
METHODS: We identified a cohort of 302 patients with CLI, from March 2007 to December 2010. Endo-first was selected if: 1) the patient had short (5-7cm occlusions or stenoses in crural vessels) 2) the disease in superficial femoral artery disease was limited to TASC II A, B or C and 3) no impending limb loss. Endo-first was performed in 187. Failures were defined as recurrent clinical signs and symptoms of CLI.
RESULTS: Secondary procedures (either endo or open) were less common after endo-first (endo 102 of 187, 55% vs. open 71 of 105, 68%; p= 0.029). Secondary revascularization was carried out using endovascular (57 of 102), open (38 of 102) and hybrid interventions (7 of 102). The 5-year limb salvage rate for endo-first with a secondary intervention was 83% and amputation-free survival (AFS) was 45%, and was no different for those not requiring a secondary intervention (Figure 1). For failures requiring open revascularization, the limb salvage and AFS rates at five years were 87% and 59%, respectively. For those treated using endovascular revascularization, the limb salvage and AFS rates at five years were 82% and 35%, respectively
CONCLUSIONS: Failed initial endovascular revascularizations for CLI requiring secondary interventions (either endovascular or open) have favorable limb salvage rates and AFS. In patients with CLI undergoing a selective endovascular-first approach for revascularization, failure does not confer poor prognosis in the long-term in properly selected patients. Furthermore, open reconstruction options may not be compromised after an endovascular intervention in appropriately selected patients.
Back to Karmody Posters
|
