Abstract 11808: Contemporary Outcomes of Bypass Surgery versus Stent-assisted Endovascular Therapy for Infrainguinal Artery Disease in Patients with Critical Limb Ischemia
Background: Little is known about the efficacy of stent-assisted endovascular treatment (EVT) in patients with critical limb ischemia (CLI) compared to bypass surgery (BSX) in a real-world practice.
Method: The study was performed as a multicenter retrospective registry. Between January 2004 and December 2009, 1053 CLI patients (1053 first treated limbs) who underwent first BSX (230 patients) or EVT (823 patients) for de novo infrainguinal lesions were identified retrospectively and analyzed. The outcome measures were amputation-free survival (AFS), overall survival, limb salvage rate and freedom from perioperative death (POD) or major adverse limb events (MALE; includes any repeat revascularization and major amputation).
Result: The mean follow interval was 35+/-20 months. Elderly patients were more frequent and diabetes, hyperlipidemia, dialysis, current smoker, coronary artery disease and heart failure were greater in the EVT group. Amputation-free survival does not differ between the BSX and EVT groups (46.4% vs. 48.7% at 5-year, Logrank P=0.85). Limb salvage and overall survival was also similar (80.2% vs. 87.3% at 5-year, Logrank P=0.24, 54.2 vs. 52.5% at 5-year, Logrank P=0.40, respectively). Among 353 patients who died during follow-up, the causes of death were cardiovascular in 61.7%. There is no significant difference of cardiovascular death between two groups (48.9% vs. 55.5%, p=0.22). Freedom from POD+MALE was significantly higher in the BSX group (64.3% vs. 50.4% at 5-year, Logrank P=0.001). However, the POD was similar in both groups (0.9% vs. 1.9%, p=0.27). After correcting with covariates, there was no significant difference in AFS (hazard ratio [HR] 1.04, 95%ConfidenciaI interval [CI] 0.82 to 1.32, adjusted P=0.75), limb salvage (HR 1.10, 95% CI 0.72 to 1.67, adjusted P=0.66) and overall survival (HR 0.92, 95% CI 0.71 to 1.20, adjusted P=0.55). However, freedom from POD+MALE was significantly higher in BSX group (HR 0.75, 95% CI 0.57 to 0.97, adjusted P=0.03).
Conclusion: Our large cohort suggested that stent-assisted EVT as a first-line treatment for CLI patients with infrainguinal disease was feasible. However, a MALE was more frequently in the EVT group.
- © 2012 by American Heart Association, Inc.