Amputation-free survival, limb symptom alleviation, and reintervention rates after open and endovascular revascularization of femoropopliteal lesions in patients with chronic limb-threatening ischemia
| Autor: | Lennart Jivegård, Klas Österberg, Angelica Perlander, Joakim Nordanstig, Mikael Svensson |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Reoperation medicine.medical_specialty Time Factors medicine.medical_treatment 030204 cardiovascular system & hematology Revascularization Risk Assessment Amputation Surgical Peripheral Arterial Disease 03 medical and health sciences 0302 clinical medicine Ischemia Risk Factors medicine Humans Popliteal Artery Prospective Studies 030212 general & internal medicine Vascular Patency Survival analysis Aged Aged 80 and over Sweden Gangrene business.industry Mortality rate Endovascular Procedures Hazard ratio Middle Aged Limb Salvage medicine.disease Progression-Free Survival Surgery Femoral Artery Amputation Bypass surgery Chronic Disease Female Vascular Grafting Cardiology and Cardiovascular Medicine business Cohort study |
| Zdroj: | Journal of Vascular Surgery. 72:1987-1995 |
| ISSN: | 0741-5214 |
| DOI: | 10.1016/j.jvs.2020.03.029 |
| Popis: | Background The optimal strategy for revascularization in chronic limb-threatening ischemia (CLTI) is not yet completely known and is still under debate. Endovascular treatment methods predominate despite limited evidence for their advantage. In this concurrent, prospective observational cohort study, we investigated outcomes after open and endovascular revascularization in the femoropopliteal segment for CLTI. Methods Between March 2011 and January 2015, there were 190 patients presenting with CLTI with the principal target lesion in the superficial femoral or popliteal segment who underwent endovascular intervention (n = 117) or bypass surgery (n = 73) and were observed prospectively. The choice of revascularization technique was based on international and local guidelines. All patients were observed for 2 years. The primary end point was amputation-free survival (AFS) assessed with Kaplan-Meier estimates; secondary end points included CLTI symptom alleviation rates and reintervention rates. A Cox proportional hazards regression model was used to investigate risk factors for amputation and death. Results AFS at 2 years was 59% in the endovascular group and 76% in the bypass group (P = .020). Kaplan-Meier survival analysis confirmed a significant difference in AFS, with mortality rate as the main driver for the observed intergroup AFS difference. In sequential multivariable regression analysis, the observed difference in AFS between the groups favored bypass surgery and remained significant after controlling for covariates of known prognostic importance (hazard ratio, 2.38; 95% confidence interval, 1.14-4.96). At 2 years, a higher proportion of patients subjected to bypass surgery remained free from ischemic rest pain, wounds, and gangrene (65% vs 45%; P = .009). The proportions of patients who underwent reintervention within 2 years were similar in the two groups (38% vs 39%; P = .90), but repeated reinterventions were more frequent in the bypass group. Conclusions At 2 years, bypass surgery was associated with higher AFS than endovascular intervention, a finding that could not be explained only by differences in case mix. More patients who had bypass surgery were free from CLTI symptoms at both 1 year and 2 years after revascularization. Reinterventions to maintain patency were equally common after bypass and endovascular intervention. |
| Databáze: | OpenAIRE |
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