Limb-Based Patency After Surgical vs Endovascular Revascularization in Patients with Chronic Limb-Threatening Ischemia
| Autor: | Yoshimitsu Soga, Tatsuya Shiraki, Norihiro Kobayashi, Makoto Utsunomiya, Nobuyoshi Azuma, Yosuke Hata, Kazunori Horie, Daiki Uchida, Masato Nakamura, Mitsuyoshi Takahara, O Iida, Tamon Kato, Akio Kodama, Junichi Tasaki, Ayumu Nagae, Nobuhiro Suematsu |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Endovascular revascularization Databases Factual Infrainguinal bypass medicine.medical_treatment Ischemia Revascularization Endovascular therapy Amputation Surgical Peripheral Arterial Disease Japan Risk Factors medicine Humans Radiology Nuclear Medicine and imaging In patient Registries Vascular Patency Aged Retrospective Studies Aged 80 and over business.industry Endovascular Procedures Middle Aged Limb Salvage medicine.disease Surgery body regions Treatment Outcome Bypass surgery Chronic Disease Female Cardiology and Cardiovascular Medicine business Vascular Surgical Procedures |
| Zdroj: | Journal of Endovascular Therapy. 27:584-594 |
| ISSN: | 1545-1550 1526-6028 |
| DOI: | 10.1177/1526602820923388 |
| Popis: | Purpose: To determine whether limb-based patency (LBP) after infrainguinal revascularization for chronic limb-threatening ischemia (CLTI) is similar between bypass surgery and endovascular therapy (EVT). Materials and Methods: The database for the Surgical Reconstruction vs Peripheral Intervention in Patients With Critical Limb Ischemia (SPINACH) study was interrogated to identify 130 patients (mean age 73±8 years; 94 men) who underwent bypass surgery and 271 patients (mean age 74±10 years; 178 men) who underwent EVT alone. Skin perfusion pressure (SPP) and the ankle-brachial index (ABI) were measured before the procedure and at 0, 1, and 3 months after revascularization. The outcome measure was hemodynamically evaluated LBP (SPP ≥10 mm Hg or ABI ≥0.1) maintained over the first 3 months after treatment. Any reintervention or major amputation was regarded as loss of LBP. The associations between the revascularization strategy (bypass vs EVT) and between the preoperative characteristics and the study outcome (ie, SPP- or ABI-based LBP), were determined using generalized linear mixed models with a logit link function. Patency rates are presented with the 95% confidence interval (CI). Results: The bypass surgery group had a higher stage of limb severity (WIfI) and anatomic complexity (GLASS) than the EVT group, whereas the EVT group had a higher prevalence of heart failure. Both SPP- and ABI-based LBP rates were higher in the bypass group than in the EVT group. SPP-based LBP rates at 3 months were 73.8% (95% CI 63.4% to 84.2%) in the bypass group and 46.2% (95% CI 38.5% to 53.8%) in the EVT group; the corresponding ABI-based LBP rates were 71.5% (95% CI 61.8% to 81.2%) and 44.0% (95% CI 37.3% to 50.7%). Conclusion: LBP is an important concept in the new global vascular guidelines for assessing the anatomic and hemodynamic status of CLTI patients. The present study found that LBP was significantly lower in the EVT group vs the bypass surgery group. |
| Databáze: | OpenAIRE |
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