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Home > Vascular Annual Meeting^® > PP50. Proportion of Critical Ischemia Patients...

PP50. Proportion of Critical Ischemia Patients Who Require an Open Surgical Procedure in a Center Favoring Endovascular Treatment

Nicholas J. Gargiulo, III1, Frank J. Veith2, Evan C. Lipsitz1
1Montefiore Medical Center, Bronx, NY; 2New York University Medical Center, New York, NY

OBJECTIVES: Endovascular interventions have gained widespread familiarity as primary and secondary treatments for critical lower extremity ischemia (CLI), and many believe there is little need for open bypasses for CLI. Despite this, some patients presenting with CLI require traditional lower extremity bypass procedures at some point for successful limb salvage. To determine the proportion of patients requiring an open procedure, we reviewed our 1-year experience in CLI patients at a center committed to endovascular approaches whenever possible.

METHODS: We reviewed all patients presenting with CLI form January 1, 2007 to December 31, 2007. CLI was defined as ischemic rest pain, non-healing ulceration, or gangrene for which a major amputation was imminently required. All patients underwent duplex and conventional angiography prior to intervention. Endovascular treatments were favored as primary, secondary or tertiary treatments, if possible. If these failed or were impossible, standard lower extremity bypasses were performed.

RESULTS: Two hundred and fifty patients presented with primary, secondary or tertiary CLI over this one year period. Of these, 75 (30%) were treated successfully with an endovascular intervention, and 165 (66%) required standard lower extremity bypass. Of these 165 patients, 95 (58%) were presenting with secondary, tertiary or more CLI after failed previous (1-5) procedures. The remaining 10 (4%) patients underwent combined endovascular and open procedures.

CONCLUSIONS: Despite the initial enthusiasm and our belief that the majority of patients presenting with CLI may be treated with endovascular procedures, there exists a large cohort of patients that will ultimately require standard open surgical procedures.

AUTHOR DISCLOSURES: N.J. Gargiulo, None; F.J. Veith, None; E.C. Lipsitz, None.