The Contemporary Safety and Effectiveness of Lower Extremity Bypass Surgery and Peripheral Endovascular Interventions in the Treatment of Symptomatic Peripheral Arterial Disease
Background—Treatment for symptomatic peripheral artery disease (PAD) includes lower extremity bypass surgery (LEB) and/or peripheral endovascular interventions (PVI); however, limited comparative effectiveness data exists between the two therapies. We assessed the safety and effectiveness of LEB and PVI in patients with symptomatic claudication and critical limb ischemia (CLI).
Methods and Results—In a community-based clinical registry at two large integrated healthcare delivery systems, we compared 883 patients undergoing PVI and 975 patients undergoing LEB between January 1st, 2005 and December 31st, 2011. Rates of Target Lesion Revascularization (TLR) were greater for PVI compared to LEB in patients presenting with claudication (12.3% ± 2.7% and 19.0% ± 3.5% at 1 and 3 years versus 5.2% ± 2.4% and 8.3% ± 3.1%, log-rank p<0.001) and CLI (19.1% ± 4.8% and 31.6% ± 6.3% and 1 and 3 years versus 10.8% ± 2.5% and 16.0% ± 3.2%, log-rank p<0.001). However, compared to PVI, LEB was associated with increased rates of complications up to 30 days following the procedure (37.1% vs. 11.9%, p<0.001). There were no differences in amputation rates between the two groups. Findings remained consistent in sensitivity analyses using propensity methods to account for treatment selection.
Conclusions—In patients with symptomatic PAD, compared to LEB, PVI was associated with fewer 30-day procedural complications, higher revascularization rates at 1 and 3 years, and no difference in subsequent amputations.
- Comparative effectiveness
- Lower extremity bypass
- Percutaneous peripheral intervention
- comparative effectiveness
- peripheral artery disease
- percutaneous procedure
- bypass surgery
- Received October 2, 2014.
- Revision received August 27, 2015.
- Accepted September 8, 2015.
Circulation is published on behalf of the American Heart Association, Inc., by Wolters Kluwer. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDervis License (http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made.