Complex and simple hybrid procedures enable multilevel revascularizations in high-risk patients with comparable patency and limb salvage. Femoral endarterectomy plays a central role, especially in complex hybrid repairs. An increase in perioperative morbidity and mortality was observed in the hybrid group, likely due to attempting revascularization in higher risk patients.

Management of early, deep groin wound infections with debridement, antibiotics, and VAC treatment is safe and enables graft preservation in the majority of patients with minimal morbidity, no perioperative limb loss, or mortality.

Amputation despite PETAS is the most common means of limb loss in patients undergoing endovascular revascularization for limb salvage. It is likely the result of aggressive attempts at limb salvage and usually occurs

PTA/S for TASC-II C lesions has a superior midterm patency than AK-FPB using PTFE, and AK-FPB with PTFE has better primary and assisted-primary patency than PTA/S-D. The TASC-II recommendations should be modified to recommend treatment of SFA TASC-II C lesions by PTA/S rather than PTFE bypass for all patients. PTA/S of TASC-II D lesions should only be considered in high-risk patients who cannot tolerate a bypass procedure using PTFE.

Patients who undergo endovascular revascularization for CLI are medically higher-risk patients. Those who have bypass have more complex disease and are more likely to require multilevel reconstruction and infrapopliteal intervention. Individualizing revascularization results in optimization of early and late outcomes with acceptable LS, although survival remains low in those with poor health status.

Our results suggest that revascularization in patients >/=80 with CLI is justified, especially when an endovascular intervention can be accomplished. Although limb salvage following endovascular interventions were better in the >/=80 group, sustained clinical success, and secondary clinical success rates were similar following open and endovascular interventions in both age groups. Open procedures carry a high perioperative mortality in the >/=80 age group and should be avoided if possible.

with open repair; however, concerns about long-term durability remain. This analysis evaluated the incidence of secondary interventions (SI) after TEVAR and determined functional outcomes and survival.Methods: A retrospective review was completed of all TEVAR patients from 2004 to 2011. Patients with SI were further analyzed. A validated questionnaire (Eastern Cooperative Oncology Group score) was used to assess ability to perform activities of daily living. Kaplan-Meier analysis was used to estimate survival.Results: Of 587 patients, 78 (13%) required SI at median Ϯ standard deviation of 4.7 months (11.5 Ϯ 16.5, Fig 1). Seventeen (22%) underwent multiple SI. Forty (6.8%) initially underwent endovascular revision, with six (15%) requiring subsequent open reintervention. Thirty-eight (6.5%) initially had open revision, with six (16%) requiring subsequent endovascular remediation. Median time to endovascular SI was 7.6 months (16.0 Ϯ 18.8), which was significantly longer than time to open SI (1.9; 6.9 Ϯ 12.3 months; P ϭ .01). SI incidence differed significantly amongst various indications (P ϭ .005): acute dissection (24.7%), chronic dissection (16.5%), degenerative aneurysm (14.1%), traumatic transection (8.3%), penetrating ulcer (1.5%), and other miscellaneous (thoracoabdominal aneurysms, mycotic aneurysms, pseudoaneurysms, 17.8%. Most common indications for SI after acute/chronic dissection were persistent false lumen perfusion and/or proximal/distal extension of disease, whereas for degenerative aneurysms, SI was performed primarily to treat type I/III endoleaks. SI patients had more comorbidities (P Ͻ .0001) and greater number of postoperative complications after the index TEVAR (P Ͻ .0001) compared with those without SI. No survival difference was noted between the groups (SI vs No SI; P ϭ .93; Fig 2). At median follow-up of 20.4 months (range, 6-52 months), functional status was significantly better among patients first treated with endovascular SI compared with open revision (Eastern Cooperative Oncology Group scale: 1.7 Ϯ 2.1 vs 2.7 Ϯ 2.1; P ϭ .04).Conclusions: SI after TEVAR is common, particularly amongst patients treated for acute dissection, which underscores the need for vigilant surveillance. Although significant functional impairment is noted after SI for TEVAR, patients can be successfully treated with open and endovascular techniques with no significant increase in long-term mortality.

Diabetic patients who present with limb ischemia can be subdivided into three distinct subgroups based on their diabetic regimen. The survival and LS rates of those controlled with diet or OM are nearly identical to nondiabetics, both of which are significantly better than OM+INS or INS. The PP rate in endovascular-treated patients is worse in patients who are on insulin. Being on insulin is independently associated with decreased survival and limb loss but not PP.