Javier E. Anaya-Ayala, Christopher J. Smolock, Charudatta S. Bavare, Mitul S. Patel, Hosam F. El-Sayed, Jean Bismuth, Eric K. Peden, Alan Lumsden, Mark G. Davies
Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center, Houston, TX.
OBJECTIVES: Over the last decade, there has been a significant increase in primary endoluminal therapy for critical limb ischemia (CLI; rest pain and tissue loss) of the lower extremity (LE) with limited reporting on patient-centered outcomes using the new objective performance goals of the SVS.
METHODS: A prospective database of patients undergoing endovascular treatment of the LE for CLI between 2000 and 2011 was queried. Patient-centered outcomes of clinical efficacy (CE; absence of recurrent symptoms, maintenance of ambulation and absence of major amputation), amputation-free survival (AFS; survival without major amputation) and freedom from major adverse limb events (MALE; Above ankle amputation of the index limb or major re-intervention (new bypass graft, jump/interposition graft revision) were evaluated.
RESULTS: Seven-hundred twenty-eight patients (60% male, age 68±14years) underwent LE interventions for CLI (66% tissue loss). Thirty-nine percent had both SFA and tibial interventions. Seventy-one percent had diabetes mellitus, 64% had hyperlipidemia and 37% had chronic renal insufficiency. Technical success was 96%. Overall MACE was 3% and MALE was 22% at 30 days. At 5 years, CE was 42±5%, (Mean±SEM), AFS 41±7% and MALE 51±4%. CE was significantly different in those presenting with rest pain and tissue loss (Figure).
CONCLUSIONS: Endoluminal therapy for CLI is associated with an early low MACE but a high MALE. Longer-term outcomes remain relatively poor with less than a 40% success in patient-centered outcomes at 5 years.
AUTHOR DISCLOSURES: J. E. Anaya-Ayala, Nothing to disclose; C. S. Bavare, Nothing to disclose; J. Bismuth, Nothing to disclose; M. G. Davies, Nothing to disclose; H. F. El-Sayed, Nothing to disclose; A. Lumsden, Nothing to disclose; M. S. Patel, Nothing to disclose; E. K. Peden, Nothing to disclose; C. J. Smolock, Nothing to disclose.
Posted April 2012