Shifting paradigms in the treatment of lower extremity vascular disease: a report of 1000 percutaneous interventions.
OBJECTIVE
Catheter-based revascularization has emerged as an alternative to surgical bypass for lower extremity vascular disease and is a frequently used tool in the armamentarium of the vascular surgeon. In this study we report contemporary outcomes of 1000 percutaneous infra-inguinal interventions performed by a single vascular surgery division.


METHODS
We evaluated a prospectively maintained database of 1000 consecutive percutaneous infra-inguinal interventions between 2001 and 2006 performed for claudication (46.3%) or limb-threatening ischemia (52.7%; rest pain in 27.7% and tissue loss in 72.3%). Treatments included angioplasty with or without stenting, laser angioplasty, and atherectomy of the femoral, popliteal, and tibial vessels.


RESULTS
Mean age was 71.4 years and 57.3% were male; comorbidities included hypertension (84%), coronary artery disease (51%), diabetes (58%), tobacco use (52%), and chronic renal insufficiency (39%). Overall 30-day mortality was 0.5%. Two-year primary and secondary patencies and rate of amputation were 62.4%, 79.3%, and 0.5%, respectively, for patients with claudication. Two-year primary and secondary patencies and limb salvage rates were 37.4%, 55.4%, and 79.3% for patients with limb-threatening ischemia. By multivariable Cox PH modeling, limb-threat as procedural indication (P < 0.0001), diabetes (P = 0.003), hypercholesterolemia (P = 0.001), coronary artery disease (P = 0.047), and Transatlantic Inter-Society Consensus D lesion complexity (P = 0.050) were independent predictors of recurrent disease. For patients that developed recurrent disease, 7.5% required no further intervention, 60.3% underwent successful percutaneous reintervention, 11.7% underwent bypass and 20.5% underwent amputation. Patency rates were identical for the initial procedure and subsequent reinterventions (P = 0.97).


CONCLUSIONS
Percutaneous therapy for peripheral vascular disease is associated with minimal mortality and can achieve 2-year secondary patency rates of nearly 80% in patients with claudication. Although patency is diminished in patients with limb-threat, limb-salvage rates remain reasonable at close to 80% at 2 years. Percutaneous infra-inguinal revascularization carries a low risk of morbidity and mortality, and should be considered first-line therapy in patients with chronic lower extremity ischemia.
DeRubertis
Brian G
BG
Division of Vascular Surgery, New York Presbyterian Hospital, Weill Medical College of Cornell University and Columbia University College of Physicians and Surgeons, New York, New York 10021, USA.
Faries
Peter L
PL
McKinsey
James F
JF
Chaer
Rabih A
RA
Pierce
Matthew
M
Karwowski
John
J
Weinberg
Alan
A
Nowygrod
Roman
R
Morrissey
Nicholas J
NJ
Bush
Harry L
HL
Kent
K Craig
KC
D000368:Aged; D000671:Amputation, Surgical; D000792:Angiography; D017130:Angioplasty / Q000379:methods; D000925:Anticoagulants / Q000627:therapeutic use; D017073:Atherectomy; D015897:Comorbidity; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000628:therapy*; D007511:Ischemia / Q000628:therapy*; D007866:Leg / Q000098:blood supply*; D023821:Limb Salvage; D008297:Male; D016491:Peripheral Vascular Diseases / Q000628:therapy*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014654:Vascular Patency
D000925:Anticoagulants
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