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Initial Hemodynamic Changes after Bypass versus Endovascular Intervention for CLI in the ACS-NSQIP Targeted Vascular Module
John C. McCallum, MD, Jeremy D. Darling, BA, Dominique B. Buck, MD, Peter A. Soden, MD, Sara L. Zettervall, MD, Marc L. Schermerhorn, MD, Raul J. Guzman, MD.
Beth Israel Deaconess Medical Center, Boston, MA, USA.
OBJECTIVE:
It has been suggested that endovascular and open interventions achieve equivalent hemodynamic results in the treatment of lower extremity vascular occlusive disease. We sought to compare the change in hemodynamic status after open versus percutaneous interventions for patients undergoing revascularization attempts for critical limb ischemia (CLI).
METHODS:
We queried the ACS-NSQIP from 2011 to 2012, the years for which targeted vascular data were available. Patients were included if they had undergone infrainguinal bypass or endovascular intervention for CLI. Non-bypass open procedures (e.g. endarterectomy) were excluded. Patients were stratified by the pre-operative ankle-brachial index (ABI). The proportion of patients in the open and endovascular groups who achieved a normal ABI or palpable pulse were compared using chi-squared and Fisher’s exact tests where appropriate.
RESULTS:
A total of 4,384 patients underwent open or endovascular infrainguinal intervention in the targeted vascular module. Among patients with CLI, bypass was performed in 1,880 (69%) and endovascular intervention in 838 (31%). In CLI patients who had a pre-operative ABI of < 0.39, there were no differences in the proportion achieving normal ABI or palpable pulse (33% vs 28%, p= .30). However, among patients with CLI who had a pre-operative ABI between 0.4 and 0.89, those undergoing open bypass surgery were significantly more likely to achieve a normal post-op ABI or palpable pulse than those undergoing a percutaneous intervention (42% vs 30%, OR 1.7, 95% CI 1.2-2.3).
CONCLUSIONS:
In this multi-institutional report of hemodynamic changes after vascular interventions for CLI, stratified analysis suggests that improvements in ABI are more likely after open bypass surgery than endovascular procedures. Further studies aimed at determining whether these differences are associated with improved wound healing and reduced adverse limb events are needed.
Post-revascularization ankle-brachial index in patients with CLI | | Post-op Normal ABI (0.9-1.3) or Palpable pulse | Pre-op ABI
<0.39 | Endo
(n=117) | 28.2% | | Open
(n=372) | 33.3% | | P-value | .30 | Pre-op ABI
0.4-0.89 | Endo
(n=254) | 29.9% | | Open
(n=459) | 41.8% | | P-value | <.001 |
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