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Home > Vascular Annual Meeting^® > RR20. Secondary Endovascular Intervention...

RR20. Secondary Endovascular Intervention After Failed Primary Intervention: Is it Warranted?

James McKinsey, Ashley Graham, Habib Khan, Gautam Shrikhande, Elliot Sambol, Roman Nowygrod, Combiz Rezayat, Rajeev Dayal, Nicholas Morrissey, K Craig Kent
New York Presbyterian Hospital, New York, NY

OBJECTIVES: There has been a dramatic increase in the incidence of endovascular intervention for the management of peripheral arterial disease (PAD). The long term durability of these interventions has been questioned as has the need for reintervention and the frequency of reintervention secondary to restenosis. The incidence of reintervention and the effectiveness of that reintervention will be evaluated.

METHODS: A prospective registry was maintained encompassing patients undergoing lower extremity revascularization from March 2004 to September 2008. Patients that underwent primary intervention were indentified. Reintervention for restenosis was performed with angioplasty (PTA), atherectomy or PTA/Stent. Noninvasive laboratory testing was performed at regular intervals postprocedurally. Perioperative indications, perioperative angiograms, operative reports and follow up data were evaluated by a dedicated research team. Statistical analysis was performed using Kaplan Meier and log-rank analysis (SPSS 17.0).

RESULTS: 1719 lesions in 715 patients underwent endovascular revascularization for PAD. Of those 1051 lesions in 530 patients (235 Claudicants and 295 Critical Limb Ischemia CLI) underwent primary intervention at this institution (mean age 71.2±10.9, 60% male, 62% DM). Mean follow up was 14.4±12.9 months. Primary patency was 47.5+2.1. (49.2±3.7% for PTA, 53.1±3.5% for atherectomy and 41±3.5 % for PTA/Stent.) 229 lesions (21.8%) in 146 patients(27.5%) required reintervention due to restenosis. Reintervention was performed with PTA 60 (26.2%), Atherectomy 68 (29.7%) and PTA/Stent 101 (44.1%) Time to reintervention was 9.3±9 months. 35 patients (55 lesions) required a second reintervention at 6.7±4.5 months, 6 patients (7 lesions) required a third reintervention and 2 patients (2 lesions) required 4 reinterventions. 24month secondary patency for the entire cohort was 72.3±1.8 and limb salvage was 75.4±2.3% in those patients with critical limb ischemia.

CONCLUSIONS: Endovascular intervention is an excellent option for management of patients with either claudication or CLI. The primary intervention coupled with secondary reintervention can lead to a long term patency and limb salvage. The need for multiple reinterventions are rare.

AUTHOR DISCLOSURES: J. McKinsey, EV3, Abbott; A. Graham, None; H. Khan, None; G. Shrikhande, None; E. Sambol, None; R. Nowygrod, None; C. Rezayat, None; R. Dayal, None; N. Morrissey, None; K. Kent, None.