Comparison of interventional outcomes according to preoperative indication: a single center analysis of 2,240 limb revascularizations.
BACKGROUND
Outcomes after lower extremity revascularization are usually reported according to the level of peripheral arterial disease (PAD, aortoiliac or infrainguinal) or the method of treatment (open or endovascular surgery). Outcomes stratified by indication, ie, claudication or critical limb ischemia (rest pain and tissue loss), have not been well studied. The purpose of this study was to compare postoperative outcomes according to the preoperative indications.


METHODS
Outcomes of 2,240 consecutive limb revascularizations in 1,732 patients from January 1998 through December 2005 were stratified and examined according to preoperative indication: claudication (n=999 limbs), ischemic rest pain (n=464 limbs), or tissue loss (n=777 limbs). End points measured included primary and secondary interventional or operative patency, limb salvage, survival, amputation-free survival, maintenance of ambulation, maintenance of independence, and resolution of presenting symptoms.


RESULTS
The proportion of medical comorbidities and the severity of disease increased significantly by cohort from claudication to rest pain to tissue loss. With a mean followup of 1,089 days (range 0 to 3,689 days), overall outcomes performance declined consistently according to indication for all end points measured at 5 years (claudication, rest pain, tissue loss, p value): secondary reconstruction patency (93%, 80%, 66%, respectively; p < 0.001), limb salvage (99%, 81%, 68%, respectively; p < 0.001), survival (78%, 46%, 30%, respectively; p < 0.001), amputation-free survival (78%, 42%, 25%, respectively; p < 0.001), maintenance of ambulation (96%, 78%, 68%, respectively; p < 0.001), maintenance of independence (98%, 85%, 75%, respectively; p < 0.001), and resolution of presenting symptoms (79%, 61%, 42%, respectively; p < 0.001).


CONCLUSIONS
There is a declining spectrum of outcomes performance from claudication to rest pain to tissue loss. These findings question the accuracy of all previously published data for critical limb ischemia, for which rest pain and tissue loss are usually blended and reported as a single outcomes value.
Taylor
Spence M
SM
Department of Surgery, Greenville Hospital System University Medical Center, University of South Carolina School of Medicine, Greenville, SC 29605 , USA.
Cull
David L
DL
Kalbaugh
Corey A
CA
Senter
Herman F
HF
Langan
Eugene M
EM
Carsten
Christopher G
CG
York
John W
JW
Snyder
Bruce A
BA
Gray
Bruce H
BH
Androes
Mark P
MP
Blackhurst
Dawn W
DW
D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000601:surgery*; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000601:surgery*; D020127:Recovery of Function; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures