title: Outcomes of infrainguinal revascularizations with endovascular first strategy in critical limb ischemia.
abstract: OBJECTIVE
  This study was designed to study the outcome of infrainguinal revascularization in patients with critical limb ischemia (CLI) in an institution with a preference towards endovascular intervention first in patients with poor condition, unfavourable anatomy for surgery, no venous material for bypass, and old age.
  
  
  METHODS
  A prospective, observational cohort study was conducted between May 2007 and May 2010 in patients presenting with CLI. At baseline, the optimal treatment was selected, i.e., endovascular or surgical treatment. In case of uncertainty about the preferred treatment, a multidisciplinary team (MDT) was consulted. Primary endpoints were quality of life and functional status 6 and 12 months after initial intervention, assessed by the VascuQol and AMC Linear Disability Score questionnaires, respectively.
  
  
  RESULTS
  In total, 113 patients were included; 86 had an endovascular intervention and 27 had surgery. During follow-up, 41 % underwent an additional ipsilateral revascularisation procedure. For the total population, and endovascular and surgery subgroups, the VascuQol sum scores improved after 6 and 12 months (p < 0.01 for all outcomes) compared with baseline. The functional status improved (p = 0.043) after 12 months compared with baseline for the total population. Functional status of the surgery subgroup improved significantly after 6 (p = 0.031) and 12 (p = 0.044) months, but not that of the endovascular subgroup.
  
  
  CONCLUSIONS
  Overall, the strategy of performing endovascular treatment first in patients with poor condition, unfavourable anatomy for surgery, no venous material for bypass, and old age has comparable or even slightly better results compared with the BASIL trial and other cohort studies. All vascular groups should discuss whether their treatment strategy should be directed at treating CLI patients preferably endovascular first and consider implementing an MDT to optimize patient outcomes.
authors.affiliation: Department of Radiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands, s.jens@amc.uva.nl.
authors.forename: Sjoerd
authors.initials: S
authors.lastname: Jens
authors.forename: Anne P
authors.initials: AP
authors.lastname: Conijn
authors.forename: Franceline A
authors.initials: FA
authors.lastname: Frans
authors.forename: Marieke B B
authors.initials: MB
authors.lastname: Nieuwenhuis
authors.forename: Rosemarie
authors.initials: R
authors.lastname: Met
authors.forename: Mark J W
authors.initials: MJ
authors.lastname: Koelemay
authors.forename: Dink A
authors.initials: DA
authors.lastname: Legemate
authors.forename: Shandra
authors.initials: S
authors.lastname: Bipat
authors.forename: Jim A
authors.initials: JA
authors.lastname: Reekers
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D000800:Angioplasty, Balloon; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D035002:Lower Extremity / Q000098:blood supply* / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology*