Impact of endovascular surgery on management of critical lower-limb ischemia in a vascular surgery department.
The authors analyzed the impact of introduction of endovascular techniques on management and evolution of critical ischemia (CI) in an Angiology and Vascular Surgery department. This is a retrospective review of patients admitted for CI during 2 2-year periods (A: January 1997-December 1998 and B: January 2000-December 2001) differentiated by introduction of endovascular techniques in 1999. Demographic data, clinical symptoms, treatment used, and evolution were recorded and compared between the 2 periods. Survival and limb salvage were analyzed by life tables and compared by log-rank test. One hundred and ninety-three admissions (limbs) for CI were recorded in period A and 226 admissions (limbs) in period B, with no differences in terms of age, sex, clinical severity, or region affected. The distribution of the treatments used in groups A, B, and group B with exclusion of endovascular techniques (B*), was as follows: revascularization (A: 67.4%; B: 50%; B*: 65%); endovascular (A: 0%; B: 23%; B*: 0%); primary amputation (A: 11.4%; B: 11.1%; B*: 14%); conservative (A: 21.2%; B: 15.9%; B*: 21%). Excluding the endovascular procedures, there were no differences between periods as regards the type of treatment or the surgical technique used. There were no differences in early mortality or complication rates. Long-term survival was significantly better in periods B and B* than in period A (p < 0.01). Insignificant improvement in limb salvage was observed in period B (A 74% vs B 82.5%; 12 months). Endovascular procedures extend the therapeutic arsenal, but they do not change management and evolution of CI. Improved survival observed in period B is maintained when endovascular procedures are excluded (period B*), so cannot be attributed only to endovascular techniques.
Heredero
A F
AF
Department of Angiology and Vascular Surgery, Hospital Universitario de Getafe, Madrid, Spain. afheredero@mi.madritel.es
Acín
Francisco
F
March
J R
JR
Utrilla
F
F
D000368:Aged; D005260:Female; D005263:Femoral Artery / Q000473:pathology / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D035002:Lower Extremity / Q000098:blood supply* / Q000473:pathology / Q000601:surgery*; D008297:Male; D011150:Popliteal Artery / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013503:Surgery Department, Hospital; D016019:Survival Analysis; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects