Is atherectomy the best first-line therapy for limb salvage in patients with critical limb ischemia?
OBJECTIVE
To determine the efficacy of atherectomy for limb salvage compared with open bypass in patients with critical limb ischemia.


METHODS
Ninety-nine consecutive bypass and atherectomy procedures performed for critical limb ischemia between January 2003 and October 2006 were reviewed.


RESULTS
A total of 99 cases involving TASC C (n = 43, 44%) and D (n = 56, 56%) lesions were treated with surgical bypass in 59 patients and atherectomy in 33 patients. Bypass and atherectomy achieved similar 1-year primary patency (64% vs 63%; P = .2). However, the 1-year limb salvage rate was greater in the bypass group (87% vs 69%; P = .004). In the tissue loss subgroup, there was a greater limb salvage rate for bypass patients versus atherectomy (79% vs 60%; P = .04).


CONCLUSIONS
Patients with critical limb ischemia may do better with open bypass compared with atherectomy as first-line therapy for limb salvage.
Loor
Gabriel
G
Department of Vascular Surgery, University of Chicago, Chicago, Illinois, USA.
Skelly
Christopher L
CL
Wahlgren
Carl-Magnus
CM
Bassiouny
Hisham S
HS
Piano
Giancarlo
G
Shaalan
Wael
W
Desai
Tina R
TR
D000368:Aged; D017073:Atherectomy / Q000009:adverse effects / Q000401:mortality; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D016638:Critical Illness; D005260:Female; D006801:Humans; D007511:Ischemia / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D014680:Veins / Q000637:transplantation