Outcomes of open and endovascular interventions in patients with chronic limb threatening ischemia
| Autor: | Robyn A. Macsata, Andrew D. Sparks, K. Benjamin Lee, John J. Ricotta, Salim Lala, Richard Amdur, Anton N. Sidawy, Bao Ngoc Nguyen |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Databases Factual Ischemia 030204 cardiovascular system & hematology Risk Assessment Endovascular therapy Amputation Surgical Peripheral Arterial Disease 03 medical and health sciences Postoperative Complications 0302 clinical medicine Risk Factors medicine Humans Radiology Nuclear Medicine and imaging In patient 030212 general & internal medicine Aged Retrospective Studies Aged 80 and over Wound Healing business.industry Endovascular Procedures General Medicine Middle Aged Vascular surgery Limb Salvage medicine.disease United States Surgery Treatment Outcome Chronic Disease Endovascular interventions Female Vascular Grafting Cardiology and Cardiovascular Medicine business |
| Zdroj: | Vascular. 29:693-703 |
| ISSN: | 1708-539X 1708-5381 |
| DOI: | 10.1177/1708538120971972 |
| Popis: | Objectives Widespread adoption of endovascular therapy for the treatment of chronic limb-threatening ischemia has transformed the field of vascular surgery. In this modern era, we aimed to define where open surgical interventions are of greatest benefit for limb salvage. Methods Patients who underwent interventions for chronic limb-threatening ischemia were identified in the vascular-targeted lower extremity National Surgical Quality Improvement Program database for open surgical interventions (OPEN) and endovascular surgical interventions (ENDO) from 2011 to 2017. Patients were further stratified based on the criteria of chronic limb-threatening ischemia (rest pain or tissue loss), and the location of the diseased arteries (femoropopliteal or tibioperoneal). The main outcomes measured included 30-day mortality, amputation, and major adverse cardiovascular events. Results A total of 17,193 patients were revascularized for chronic limb-threatening ischemia: 10,532 were OPEN and 6661 were ENDO. OPEN had higher 30-day mortality, major adverse cardiovascular events, pulmonary, renal dysfunction, and wound complications. However, OPEN resulted in significantly lower 30-day major amputation (3.8% vs. 5.0%, odds ratio (OR): 0.83 [0.72–0.97], P = .018). Subgroup analysis revealed a higher mortality rate in OPEN was observed only in tibioperoneal intervention for tissue loss. Major adverse cardiovascular event was higher in OPEN for most subgroups. OPEN for patients with tissue loss had significantly lower amputation rate than ENDO in both femoropopliteal and tibioperoneal subgroups (3.7% vs. 5.1%, OR: 0.76 [0.59–0.98], P = .036, and 4.7% vs. 6.6%, OR: 0.74 [0.57–0.96], P = .024, respectively). The benefit of open surgery in reducing the amputation rate was not seen in patients with rest pain. Conclusions Open surgical intervention is associated with significantly better limb salvage than endovascular intervention in patients with tissue loss. Surgical options should be given more emphasis as the first-line option in this cohort of patients unless the cardiopulmonary risk is prohibitive. |
| Databáze: | OpenAIRE |
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