Below-knee endovascular interventions have better outcomes compared to open bypass for patients with critical limb ischemia

Caitlin W. Hicks, Alireza Najafian, Alik Farber, Matthew T. Menard, Mahmoud B. Malas, James H. Black, Christopher J. Abularrage

Research output: Contribution to journalArticle

Abstract

Both open surgery and endovascular peripheral interventions have been shown to effectively improve outcomes in patients with peripheral artery disease, but minimal data exist comparing outcomes performed at and below the knee. The purpose of this study was to compare outcomes following infrageniculate lower extremity open bypass (LEB) versus peripheral vascular intervention (PVI) in patients with critical limb ischemia. Using data from the 2008-2014 Vascular Quality Initiative, 1-year primary patency, major amputation, and mortality were compared among all patients undergoing LEB versus PVI at or below the knee for rest pain or tissue loss. Overall, 2566 patients were included (LEB=500, PVI=2066). One-year primary patency was significantly worse following LEB (73% vs 81%; p<0.001). One-year major amputation (14% vs 12%; p=0.18) and mortality (4% vs 6%; p=0.15) were similar regardless of revascularization approach. Multivariable analysis adjusting for baseline differences between groups confirmed inferior primary patency following LEB versus PVI (HR 0.74; 95% CI, 0.60-0.90; p=0.004), but no significant differences in 1-year major amputation (HR 1.06; 95% CI, 0.80-1.40; p=0.67) or mortality (HR 0.71; 95% CI, 0.44-1.14; p=0.16). Based on these data, we conclude that endovascular revascularization is a viable treatment approach for critical limb ischemia resulting from infrageniculate arterial occlusive disease.

LanguageEnglish (US)
Pages28-34
Number of pages7
JournalVascular Medicine (United Kingdom)
Volume22
Issue number1
DOIs
StatePublished - Feb 1 2017

Fingerprint

Blood Vessels
Lower Extremity
Knee
Ischemia
Extremities
Amputation
Mortality
Nociceptive Pain
Arterial Occlusive Diseases
Peripheral Arterial Disease
Therapeutics

Keywords

  • angioplasty
  • bypass grafting
  • critical limb ischemia (CLI)
  • lower extremity
  • peripheral arterial disease (PAD)
  • popliteal artery
  • registries
  • tibial artery
  • treatment outcome
  • vascular surgical procedures

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Below-knee endovascular interventions have better outcomes compared to open bypass for patients with critical limb ischemia. / Hicks, Caitlin W.; Najafian, Alireza; Farber, Alik; Menard, Matthew T.; Malas, Mahmoud B.; Black, James H.; Abularrage, Christopher J.

In: Vascular Medicine (United Kingdom), Vol. 22, No. 1, 01.02.2017, p. 28-34.

Research output: Contribution to journalArticle

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