|Shifting Paradigms In the Treatment of Lower Extremity Vascular Disease: A Report of 1000 Percutaneous Interventions|
|Brian G DeRubertis*, Peter L. Faries*, James F. McKinsey*, Matthew Pierce*, Alan Weinberg*, Roman Nowygrod, Nicholas J. Morrissey*, John Karwowski*, Harry L. Bush*, K. Craig Kent |
Weill Medical College of Cornell University, Columbia College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY
|OBJECTIVE(S): Catheter-based revascularization has emerged as an alternative to surgical bypass for lower extremity vascular disease and is increasingly utilized by vascular surgeons. This study reports outcomes of 1000 infra-inguinal interventions performed by a single vascular surgery division.|
METHODS: We evaluated a prospectively maintained database of catheter interventions (2000-2006) performed for claudication (46%) or limb-threatening ischemia (15% rest pain, 39% tissue loss). Treatments included angioplasty with or without stenting, laser angioplasty, and atherectomy of the femoropopliteal/tibial vessels.
RESULTS: Mean age was 71, 58% were male; co-morbidities included HTN(85%), CAD(52%), diabetes(58%), tobacco use(52%), and renal insufficiency(22%). Overall 30-day mortality was 0.51%. Two-year primary and secondary patencies and rate of amputation were 57.1%, 77.8% and 0.6%, respectively, for claudicants(Fig.1). Two-year primary and secondary patencies and limb salvage rates were 31.4%, 54.7% and 77.2% for patients with limb-threat(Fig.2). By multivariable Cox PH modeling, limb-threat as procedural indication(p<0.0001), diabetes(p=0.0029), hypercholesterolemia(p=0.0013), and CAD(p=0.0468) were independent predictors of recurrent disease. Of these patients, 55% underwent successful percutaneous re-intervention, 9.9% underwent bypass, 18.7% underwent amputation and 16.0% required no further intervention. Patencies were identical for initial procedures and subsequent re-interventions(p=0.97).
CONCLUSION: Percutaneous therapy for peripheral vascular disease is associated with minimal mortality and can achieve 2-year secondary patency rates of nearly 80% in claudicants. While patency is diminished in patients with limb-threat, limb-salvage rates remains similar to that of surgical bypass.