Comparative effectiveness of endovascular versus surgical revascularization for acute lower extremity ischemia

Taha, Ashraf G.; Byrne, Raphael M.; Avgerinos, Efthimios D.; Marone, Luke; Makaroun, Michel S.; Chaer, Rabih A.

doi:10.1016/j.jvs.2014.06.109

Cited by 113 publications

(74 citation statements)

References 10 publications

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“…In this comprehensive multicenter registry, we found a technical failure rate of 11% among ALI patients treated with PVI, which is comparable to those previously reported 18, 20, 21. One study found a technical failure rate of 1.6%,19 but this lower rate may reflect the difference in endovascular treatment techniques used.…”

Section: Discussionsupporting

confidence: 86%

“…Our in‐hospital and 1‐year mortality of 4% and 15% were comparable to 3% to 4% and 14.3% to 18% presented from these single‐center studies 18, 19, 20, 21, 22. Interestingly, our 6% major amputation rate at 1 year after PVI was significantly lower than the rates of 13% to 32% as previously reported 18, 20, 21, 22. This may be because of the heterogeneity in patient selection and Rutherford class severity among the studies.…”

Section: Discussionsupporting

confidence: 78%

“…Baril et al reviewed data from the 1998–2009 Medicare Provider Analysis & Review (MedPAR) files and demonstrated that patients hospitalized for management of ALI had high burden of known atherosclerotic risk factors and noted a significant rise in the prevalence of these comorbidities, including diabetes mellitus, hypertension, hyperlipidemia, and atrial fibrillation over the past decade 14. Additionally, past studies showed that patients presenting with ALI often have prior history of previous ipsilateral revascularizations, consistent with underlying advanced peripheral arterial disease in these patients 1, 18, 19, 20, 21…”

Section: Discussionmentioning

confidence: 98%

“…One study found a technical failure rate of 1.6%,19 but this lower rate may reflect the difference in endovascular treatment techniques used. Some single‐center studies18, 20, 21 utilized catheter‐direct thrombolysis with recombinant tissue plasminogen activator±percutaneous mechanical thrombectomy as the initial intervention in all of their ALI patients, while Linnemann et al19 included ALI patients treated by a multitude of techniques, such as mechanical thrombectomy, catheter thrombus aspiration, local thrombolysis, angioplasty, stent placement, and atherectomy. Our in‐hospital and 1‐year mortality of 4% and 15% were comparable to 3% to 4% and 14.3% to 18% presented from these single‐center studies 18, 19, 20, 21, 22.…”

Section: Discussionmentioning

confidence: 99%

“…Some single‐center studies18, 20, 21 utilized catheter‐direct thrombolysis with recombinant tissue plasminogen activator±percutaneous mechanical thrombectomy as the initial intervention in all of their ALI patients, while Linnemann et al19 included ALI patients treated by a multitude of techniques, such as mechanical thrombectomy, catheter thrombus aspiration, local thrombolysis, angioplasty, stent placement, and atherectomy. Our in‐hospital and 1‐year mortality of 4% and 15% were comparable to 3% to 4% and 14.3% to 18% presented from these single‐center studies 18, 19, 20, 21, 22. Interestingly, our 6% major amputation rate at 1 year after PVI was significantly lower than the rates of 13% to 32% as previously reported 18, 20, 21, 22.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of Peripheral Vascular Interventions in Select Patients With Lower Extremity Acute Limb Ischemia

Inagaki

Farber

Kalish

et al. 2018

JAHA

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BackgroundContemporary data on patients presenting with acute limb ischemia (ALI), who are selected for treatment with endovascular peripheral vascular interventions (PVI), are limited. Our study examined outcomes following endovascular PVI in patients with ALI by comparing with patients treated for chronic critical limb ischemia using a regional quality improvement registry.Methods and ResultsOf the 11 035 patients in the Vascular Study Group of New England PVI database (2010–2014), we identified 365 patients treated for lower extremity ALI who were 5:1 frequency matched (by procedure year and arterial segments treated) to 1808 patients treated for critical limb ischemia. ALI patients treated with PVI had high burden of atherosclerotic risk factors and were more likely to have had prior ipsilateral revascularizations. ALI patients were less likely to be treated with self‐expanding stents and more likely to undergo thrombolysis than patients with critical limb ischemia. In multivariable analysis, ALI was associated with higher technical failure (odds ratio 1.7, 95% confidence interval, 1.1%–2.5%), increased rate of distal embolization (odds ratio 2.7, 95% confidence interval, 1.5%–4.9%), longer length of stay (means ratio 1.6, 95% confidence interval, 1.4%–1.8%), and higher in‐hospital mortality (odds ratio 2.8, 95% confidence interval, 1.3%–5.9%). ALI was not associated with risk of major amputation or mortality at 1 year.ConclusionsIn a multicenter cohort of patients treated with PVI, we found that ALI patients selected for treatment with endovascular techniques experienced greater short‐term adverse events but similar long‐term outcomes as their critical limb ischemia counterparts. Further studies are needed to refine the selection of ALI patients who are best served by PVI.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Outcomes of Peripheral Vascular Interventions in Select Patients With Lower Extremity Acute Limb Ischemia

Inagaki

Farber

Kalish

et al. 2018

JAHA

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A 55‐Year‐Old Man with Leg Pain

2019

Cardiology Board Review

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Importance of Successful Revascularization in Acute Limb Ischemia: Sub‐Analysis From the RESCUE ALI Trial

Haraguchi,

Tan,

Uchida

et al. 2024

Cathet Cardio Intervent

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BackgroundThis study aimed to assess the 1‐year clinical outcomes and predictors of technical success in acute limb ischemia (ALI) treatment.MethodsA sub‐analysis of the REtroSpective multiCenter study of endovascUlar or surgical intErvention for ALI (RESCUE ALI) study involved 185 patients with ALI and technical success (n = 131) or failure (n = 54) treated via surgical, endovascular, or hybrid revascularization between January 2015 and August 2021. The primary endpoint was 1‐year amputation‐free survival (AFS), and the secondary endpoints included preoperative complications and 1‐year reintervention.ResultsThe technical success group had a significantly higher 1‐year AFS rate than the technical failure group (79% vs. 44%, p < 0.001). Perioperative complications rate showed no significant difference between the two groups. The incidence of reintervention was lower in the technical success group (17% vs. 30%, p = 0.049). Age ≥ 80 years, time from onset ≥ 24 h, no below‐the‐knee artery runoff, and preoperative c‐reactive protein ≥ 5 mg/dL were negatively associated with technical success across all procedures. In surgical revascularization, no below‐the‐knee artery runoff was negatively associated with technical success. For endovascular revascularization, onset‐to‐treatment time ≥ 48 h was negatively related and thromboembolism in atrial fibrillation was positively related to technical success. In hybrid revascularization, supra‐ to infrapopliteal lesions were negatively associated with technical success.ConclusionsTechnical success in ALI treatment significantly enhances 1‐year AFS rates. Thus, choosing the appropriate revascularization procedure based on predictors of technical success is crucial for improving patient outcomes.

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Comparative effectiveness of endovascular versus surgical revascularization for acute lower extremity ischemia

Cited by 113 publications

References 10 publications

Outcomes of Peripheral Vascular Interventions in Select Patients With Lower Extremity Acute Limb Ischemia

Outcomes of Peripheral Vascular Interventions in Select Patients With Lower Extremity Acute Limb Ischemia

A 55‐Year‐Old Man with Leg Pain

Importance of Successful Revascularization in Acute Limb Ischemia: Sub‐Analysis From the RESCUE ALI Trial

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