Outcome predictors in selection of balloon angioplasty or surgery for peripheral arterial occlusive disease. Veterans Administration Cooperative Study No. 199.
In a selected group of men, surgical bypass and percutaneous balloon angioplasty (PTA) are equally effective therapy for ileo-femoropopliteal occlusive disease, provided immediate PTA failures are disregarded. Can we predict those patients likely to experience immediate PTA failure? Do any preintervention factors exist that favor PTA or surgical bypass for the remaining patients? Logistic regression analysis determined variables predictive of failure for the 19 immediate PTA failures and for the 17 patients with PTA and the 24 patients with surgical bypass who failed after initial intervention but before the end of 2 years. Two hundred sixty-three patients were enrolled. The analysis evaluated patient characteristics (age, weight, smoking status, diabetic status, and sickness impact profile score) as well as lesion site, percent lesion stenosis, runoff status, hemodynamic parameters, and indications. Two independent predictors of immediate PTA failure were diastolic hypertension (p = 0.032) and percent stenosis of study site (p = 0.035). The probability equation defined by the logistic regression analysis delineates patients at high risk for immediate PTA failure. Interestingly, no factor uniquely predicted delayed PTA or surgical failure. These data suggest that selected patients with diastolic hypertension and a severely stenotic or occluded artery are poor candidates for PTA. Either PTA or surgical bypass is effective therapy for the remaining patients.
Dalsing
M C
MC
Department of Surgery, Indiana University Medical Center, Indianapolis 46202.
Cockerill
E
E
Deupree
R
R
Wolf
G
G
Wilson
S
S
D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000601:surgery / Q000628:therapy*; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012307:Risk Factors; D013223:Statistics as Topic; D014656:Vascular Surgical Procedures