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Little is known about the efficacy of endovascular therapy (EVT) in patients with critical limb ischemia (CLI) compared to bypass surgery (BSX).
Between January 2004 and December 2009, 1043 CLI patients (460 first treated limbs) who underwent BSX (230 patients) or EVT (823 patients) for de novo infrainguinal lesions were identified retrospectively. Propensity score analysis was used for risk adjustment in multivariable analysis and for one–to–one matching (BSX: 200, EVT 200). The endpoints were amputation–free survival (AFS) limb salvage, overall survival, and freedom from major adverse limb events (MALE; includes any repeat revascularization and major amputation).
In overall series, there is no significant difference in AFS, Limb salvage and overall survival at 5–year between the BSX and EVT groups (46.4% vs. 48.4%, P=0.84, 80.2% vs. 87.3%, P=0.24 and 54.2% vs. 52.5%, P=0.40, respectively). However, Freedom from MALE was significantly lower in the EVT group (64.9% vs. 51.4%, P=0.02). In the propensity score–matched pairs, there was no significant difference in all endpoints (AFS, limb salvage, overall survival and freedom from MALE) between BSX and EVT (47.5% vs. 56.0%, P=0.44, 80.3% vs. 88.8%, P=0.44, 55.9% vs. 57.7%, P=0.61 and 67.1% vs. 60.1%, P=0.27, respectively).
Our cohort suggested that serious adverse events after EVT seemed to be acceptable compared to that after BSX in CLI patients who received first infrainguinal revascularizatiion.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.–4:30 p.m.
Session Title: Vascular Medicine: Endovascular Therapy I
Abstract Category: 34. Vascular Medicine: Endovascular Therapy
Presentation Number: 1165–161
- 2013 American College of Cardiology Foundation