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Clinical Presentation and Outcome Following Failed Endovascular and Open Revascularization in Patients with Chronic Limb Ischemia
Hasan H. Dosluoglu, MD1, Purandath Lall, MBBS1, Linda M. Harris, MD2, Maciej L. Dryjeski, MD2.
1VA Western NY Healthcare System, SUNY at Buffalo, Buffalo, NY, USA, 2SUNY at Buffalo, Buffalo, NY, USA.

Objectives: Prior endovascular interventions have been reported to have a negative impact on the final outcomes. The goal of our study was to compare the clinical presentation of patients who failed endovascular (EV) and Open revascularizations (OR), and impact of the initial intervention on final outcomes.
Methods: From 06/2001-10/2010, 216 patients (237 limbs; 66 DC, 171 CLI) presented with failed OR of EV revascularization for chronic limb ischemia. Clinical presentation, re-interventions, patency and limb salvage (LS) rates and final outcomes were analyzed.
Results: The EV group (N=143) had more diabetes (44% vs. 57%, P=0.048), ulcer (26% vs. 38%, P=0.039) while the OR group (N=94) had more multilevel revascularization (59% vs. 33%, P<0.001). Presentation at the time of failure was non-limb threatening ischemia in 70% of DC, 16% of CLI patients (P<0.001), with no difference in those initially treated with EV or OR. In CLI, more presented with acute limb ischemia in OR than EV group (23% vs. 10%, P=0.024). Early failure (< 3mths) occurred in 15% of DC and 36% of CLI patients, and was more in OR than EV groups (30% vs 7% for DC, P=0.011, and 71% vs.38% for CLI, P=0.024). Overall, 195 (82%) had attempted re-interventions (79% in DC, 85% in CLI P=0.245). In DC patients, 47% of OR had open±EV, 26% had EV; 32% of EV had open±EV, 47% had EV reinterventions. In CLI patients, 43% of OR had open±EV, 39% had EV; 16% of EV had open±EV, 70% had EV reinterventions. A patent revascularized limb was achieved in 66% of OR, and 92% of EV groups (P<0.001). Patency and LS were significantly better in the EV group, mainly due to the difference in CLI patients, while survival was identical (Table).
Conclusions: Clinical presentation following failed revascularization is determined by the initial indication (DC vs. CLI). CLI patients are more likely to present with acute limb ischemia, and within 3 months of revascularization, especially following open revascularization. Endovascular re-interventions play a significant role in management of patients with failed revascularization, and EV failure is associated with better outcomes than those following Open revascularization.
Patency, Limb salvage and survival after Failure of EV or Open Revascularization
All limbs24mo PP24 mo SP24 mo Overall (tertiary) patency24 mo LS (*CLI only)Survival
Open(94)28±5%32±6%55±6%63±5%
53±6%*
69±5%
EV(143)42±5%58±5%78±4%84±4%
77±5%*
73±4%
P value0.001<0.001<0.001<0.001
<0.001*
0.737
Attempted revascularization only
Open44±8%50±8%69±6%64±6%
56±7%*
67±6%
EV56±6%75±5%93±3%84±4%
77±5%*
73±5%
P value0.011<0.001<0.0010.001
0.006*
0.952


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