Infrainguinal revascularization because of claudication: total long-term outcome of endovascular and surgical treatment.
OBJECTIVE
This study was undertaken to define total long-term outcome achievable with invasive treatment, ie, endovascular or surgical, in patients with claudication with infrainguinal lesions. Priority in primary treatment was given to percutaneous transluminal angioplasty.


METHODS
Data were analyzed for 233 consecutive patients with claudication in whom primary infrainguinal revascularization was performed in 304 limbs between 1989 and 1992. Patients were followed-up to May 2001 (mean, 81 months). Treatment included primary endovascular therapy when applicable (n = 272 limbs) or primary surgical treatment (n = 32; 10.5%). Type of further revascularization, if required, was selected on an individual basis for each patient. All procedures performed because of limb ischemia were recorded. Clinical outcome at the end of follow-up was compared with the preoperative condition. Cumulative primary, secondary, and total patency rates and development of chronic critical ischemia (CCI) were defined. Total patency reflects the ultimate achievable benefit of invasive treatment and refers to patency maintained at the primarily treated segment by means of any invasive (endovascular or surgical) therapy, including potential crossover to another treatment group.


RESULTS
A mean of 2 (median, 1) operations per limb were performed during follow-up. No additional operations were needed in 50.3% (n = 153) of limbs. Fontaine classification at the end of the study was better compared with the preoperative value (P <.0005). Crossover between endovascular and surgical treatment was recorded in 21.1% (n = 64) of limbs. At 5 years, primary, secondary, and total patency rates (plus or minus standard error of estimate [SEE]) were 27% +/- 3%, 45% +/- 3%, and 61% +/- 3%, respectively, and at 10 years these rates were 16% +/- 3%, 27% +/- 3%, and 41% +/- 3%. CCI developed in 37 limbs (12.2%), of which 15 (41%) had been treated with endovascular methods only. Type II diabetes and hypertension were statistically significant predictors of increased risk for CCI.


CONCLUSIONS
Combining endovascular and surgical methods when necessary improved total outcome of invasive infrainguinal treatment of claudication. Crossover between endovascular and surgical treatment was required in 21% of limbs over the long term.
Jämsén
Tiia S
TS
Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland. Tiia.Jamsen@timnet.ti
Manninen
Hannu I
HI
Tulla
Harri E
HE
Jaakkola
Pekka A
PA
Matsi
Pekka J
PJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D017130:Angioplasty / Q000379:methods; D000800:Angioplasty, Balloon / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D019091:Critical Pathways; D003935:Diagnostic Techniques, Cardiovascular; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000150:complications / Q000601:surgery / Q000628:therapy*; D007511:Ischemia / Q000209:etiology* / Q000601:surgery; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014654:Vascular Patency