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Home > Vascular Annual Meeting > PP43. Underlying Comorbidities Are More Important...

PP43. Underlying Comorbidities Are More Important than Procedure Type in Determining Outcomes Following Intervention for Critical Limb Ischemia

Bantayehu Sileshi1, Jose Trani2, Sandra S. Stinnett1, Michael J. Miller, Jr.1, Cynthia K. Shortell1
1Duke University Medical Center, Durham, NC; 2University of North Carolina Medical Center, Chapel Hill, NC

OBJECTIVES: Endovascular approaches for limb salvage in critical limb ischemia (CLI) offer the potential of reduced cardiovascular risk compared to open procedures. To date, no study has compared open and endovascular interventions regarding cardiovascular events (CVE) using a cardiac risk stratification system. This study sought to determine if endovascular interventions in CLI patients reduced CVE when compared to open treatment, while standardizing cardiac risk using the Revised Cardiac Risk Index (RCRI).

METHODS: 116 patients treated for CLI at our institution in 2005 were retrospectively identified. Outcomes were recorded at 30 days and one year after the index intervention. Data was collected on revascularization method, RCRI score, tobacco use, Rutherford classification, BMI, ambulatory status, lesion location, diabetes, dialysis dependence, anesthetic type, and need for second intervention. Outcomes included 30-day CVE rates, one-year amputation rate, a one-year composite index of CVE or amputation, and one-year mortality. A stepwise logistic regression analysis was performed to select significant variables. These variables were then used to build a multivariable logistic model that also included procedure type, RCRI score and interaction terms between these variables.

RESULTS: 62 patients were treated with an open procedure and 54 via a percutaneous approach. Basic demographic characteristics were similar between groups. There was no statistically significant difference in 30-day or 1-year CVE rates, 1-year amputation, or 1-year mortality when comparing percutaneous and open revascularization and controlling for all other variables (p≥0.35). Patients with higher RCRI score (OR 1.87 CI [1.19, 2.94]) and dialysis dependent (OR 2.71 CI [1.29, 5.67]) had increased 1-year mortality. Obese patients (BMI>30) (OR 4.73 CI [0.9, 24.9]) trended towards increased 30-day cardiovascular events. There was no statistically significant interaction between significant variables and type of procedure.

CONCLUSIONS: Our study shows that there was no difference in the incidence of CVE between percutaneous and open revascularization. These results suggest that baseline cardiovascular risk factors contribute more to post-intervention cardiovascular morbidity than the type of intervention.

AUTHOR DISCLOSURES: B. Sileshi, None; J. Trani, None; S.S. Stinnett, None; M.J. Miller, None; C.K. Shortell, None.