Comparison of Long Term Outcomes After Endovascular Treatment Versus Bypass Surgery in Chronic Limb Threatening Ischaemia Patients with Long Femoropopliteal Lesions

Zlatanović, Petar; Mahmoud, A. A.; Činara, Ilijas; Cvetić, Vladimir; Lukic, Borivoje; Davidović, Lazar

doi:10.1016/j.ejvs.2020.11.009

Cited by 17 publications

(8 citation statements)

References 42 publications

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“…43 Similar outcomes were reported in another study with a significantly higher incidence of wound infection requiring prolonged hospital stay following surgery. 44 The presence of comorbidities significantly influences the postoperative outcomes in CLTI patients and should be considered before choosing the treatment options. The main limitations of our study were the short follow-up period and smaller sample size.…”

Section: Discussionmentioning

confidence: 99%

Effect of Comorbidities on Outcomes of Infrapopliteal Angioplasty in Patients with Chronic Limb-Threatening Ischemia

Vivekanand

Motukuru

Kolalu

et al. 2022

Innovations�(Phila)

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Objective: This subgroup analysis aimed to evaluate the effect of comorbidities on infrapopliteal angioplasty outcomes in patients with chronic limb-threatening ischemia (CLTI). Methods: This was an observational study evaluating eligible CLTI patients aged >18 years who underwent infrapopliteal angioplasty between April 2014 and May 2017 at a tertiary care center. Subgroup analyses were based on (1) baseline glycated hemoglobin (HbA1c ≤6.5% vs >6.5%), (2) presence/absence of chronic kidney disease (CKD), and (3) control of lipid parameters. Results: A total of 231 patients with 332 infrapopliteal vessels were treated. While diabetes was prevalent in all participants, hypertension, coronary artery disease, and CKD were reported in 76.6%, 46.3%, and 25.5% of patients at baseline, respectively. The overall technical success rate was 84.4%, and the patency rate at 6 months was 82.04%. Patency at 6 months, wound healing, in-line flow, and complete plantar arch formation were numerically higher in patients with HbA1c ≤6.5% versus >6.5%, but all comparisons were nonsignificant. According to multivariable analysis, the odds of wounds not healing was 2.38 times higher (odds ratio [OR] = 2.4, 95% confidence interval [CI]: 1.2 to 4.5) and developing plantar arch was 5.88 times higher (OR = 5.9, 95% CI: 1.3 to 25) among patients with CKD compared with patients without CKD. Conclusions: The 6-month outcomes of infrapopliteal angioplasty may be better in patients with controlled versus uncontrolled glycemic levels. Control of lipid parameters may not have a significant influence on outcomes, especially in patients on statin therapy. The short-term outcomes may be similar in patients with and without CKD.

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Section: Discussionmentioning

confidence: 99%

Effect of Comorbidities on Outcomes of Infrapopliteal Angioplasty in Patients with Chronic Limb-Threatening Ischemia

Vivekanand

Motukuru

Kolalu

et al. 2022

Innovations�(Phila)

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“…Aus den Ergebnissen schlussfolgerten die Autorinnen und Autoren, dass die Bypassoperation bei femoropoplitealen Läsionen der Klassen III und IV bei Patientinnen und Patienten mit CLTI in Bezug auf die eher längerfristige primäre Durchgängigkeit und die Reinterventionsrate überlegen zu sein scheint, allerdings mit deutlich höheren postoperativen Komplikationsraten. Ein offener chirurgischer Zugang kann bei ausgewählten Patientinnen und Patienten als erste Wahl angesehen werden, insbesondere, wenn eine geeignete V. saphena magna verfügbar ist [ 16 ].…”

Section: Diskussionunclassified

Topicality of the fundamental and determining importance of chronic critical ischemia of the extremities and its restorative treatment using crural/pedal bypasses in Germany and in Saxony-Anhalt

Barth,

Lehmann,

Meyer

et al. 2023

Chirurgie

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Zusammenfassung Hintergrund Aktuell ist eine Zunahme der schweren Stadien der peripheren arteriellen Verschlusskrankheit (pAVK) mit kritischer Ischämie zu verzeichnen. Dies scheint sowohl dem allgemeinen demographischen Wandel zu entsprechen als auch eine Folge der SARS-CoV-2(„severe acute respiratory syndrome coronavirus 2“)-Pandemie der letzten 3 Jahre zu sein. Das mittlerweile etablierte und akzeptierte interventionelle/endovaskuläre Vorgehen bei einer schweren Unterschenkel-pAVK in erfahrener Hand gilt nach wie vor als „First-line“-Therapie, jedoch erlebt aus eigener Sicht der krurale/pedale Venenbypass eine Renaissance. Material und Methoden Kompakte narrative Übersicht über den aktuellen Stand der kruralen/pedalen Bypasschirurgie in Deutschland und Sachsen-Anhalt (SA), kombiniert mit selektiven Referenzen der aktuellen wissenschaftlich-medizinischen Literatur und eigenen klinischen Erfahrungen. Ergebnisse Eine aktuelle Statistik der fallbezogenen DRG(„diagnosis related groups“)-Daten zeigt, dass insbesondere mit Auftreten der Corona-Pandemie ein Rückgang der stationären Fallzahlen von Patienten mit einem pAVK-Stadium IIB bundesweit und ebenfalls im Bundesland SA zu verzeichnen ist. Die schweren pAVK-Stadien blieben in den Fallzahlen annähernd gleich, in SA jedoch zunehmend. Die WIFI-Klassifikation bietet die Möglichkeit, über ein Punktesystem Aussagen über das Amputationsrisiko, Nutzen und Art der Revaskularisationsmaßnahme erstellen zu können. Verschlusslänge, Verschlusslokalisation der betroffenen Gefäße und Verkalkungsgrad finden Berücksichtigung im Global-Limb-Anatomic-Staging-System (GLASS) zur Beurteilung der Prognose. Die Auswertung der Fallpauschalenbezogenen Krankenhausstatistik von 2015 bis 2020 ergab eine konstante Anwendung der femorokruralen/-pedalen Bypasschirurgie in Deutschland sowie eine leichte Zunahme der Rekonstruktion mittels femorokruraler Bypässe in SA, die mit dem tendenziellen Fallzahlenanstieg der schweren pAVK zu korrelieren scheint. Schlussfolgerung Zur Indikationsstellung für die Anlage eines kruralen/pedalen Bypasses sollte die parameterbasierte Objektivierung des Schweregrades der kritischen Extremitätenischämie mit einbezogen werden. Dafür eignen sich die WIFI-Klassifikation und GLASS, da hier auch eine relative Erfolgsprognose möglich ist. Die Behandlung der kritischen Extremitätenischämie mittels kruraler/pedaler Bypasschirurgie findet in Deutschland und SA nach wie vor eine konstante Anwendung.

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“…Although this surgical approach may offer better primary patency and more rapid wound healing than endovascular therapy, it is associated with general complications, prolonged recovery, rehospitalizations, and re-operations. [8][9][10][11][12][13][14][15] Endovascular therapies including percutaneous transluminal angioplasty (PTA) and stent placement are less invasive than open surgery and are increasingly used in the treatment of CLTI. Endovascular revascularization is widely considered the first treatment option for femoropopliteal (FP) arteriosclerosis, due to reproducible and acceptable clinical results.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Randomized clinical Trial Comparing drug Eluting Stent Zilver PTX® Versus Bare Metal Stent Zilver Flex® for Treatment of Lesions in Femoral and Popliteal Arteries in Chronic Limb Threatening Ischemia

Fransson

Gottsäter

Abdulrasak

et al. 2023

Vasc Endovascular Surg

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Objective Drug eluting stents (DES) might improve the results of stenting in the femoropopliteal (FP) segment, but randomized data between DES and BMS in the treatment of patients with chronic limb threatening ischemia (CLTI) is lacking. The aim of this study was to perform a randomized comparison, between DES and bare metal stent (BMS) implantation in a subgroup of CLTI patients with lesions in the superficial femoral artery (SFA) and the P1-P2 portion of the popliteal artery. Methods Patients presenting with CLTI scheduled for endovascular treatment of FP lesions were randomly assigned by blinded envelopes 1:1 in a single blinded, parallel group design to DES or BMS after lesion crossing. Primary endpoints were target lesion revascularization (TLR) at 12 and 24 months and primary patency at 12 and 24 months. Secondary endpoints were technical success (TS), clinical success, secondary patency at 12 and 24 months, limb salvage, serious adverse events (SAE) at 24 month and survival at five years. Results A total of 48 CLTI patients and 49 limbs, were enrolled, 22 in the BMS group and 27 in the DES group. Demographics, comorbidities, and Rutherford class were similar in both treatment arms. The overall rate of total occlusions was 96% and the corresponding overall median lesion length was 240 mm. No patients were lost to follow up. No significant differences were detected between groups regarding TLR and primary patency. The overall primary patency at 12 and 24 months was 42.9% and 36.7% respectively and the overall freedom from TLR was 67.3% and 61.2% respectively. The results in the two groups were also similar regarding secondary outcomes. Conclusions This single centre, randomized study could not demonstrate superiority of DES compared to BMS when treating long FP lesions in patients with CLTI but was limited by insufficient patient inclusion.

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Comparison of Long Term Outcomes After Endovascular Treatment Versus Bypass Surgery in Chronic Limb Threatening Ischaemia Patients with Long Femoropopliteal Lesions

Cited by 17 publications

References 42 publications

Effect of Comorbidities on Outcomes of Infrapopliteal Angioplasty in Patients with Chronic Limb-Threatening Ischemia

Effect of Comorbidities on Outcomes of Infrapopliteal Angioplasty in Patients with Chronic Limb-Threatening Ischemia

Topicality of the fundamental and determining importance of chronic critical ischemia of the extremities and its restorative treatment using crural/pedal bypasses in Germany and in Saxony-Anhalt

Randomized clinical Trial Comparing drug Eluting Stent Zilver PTX® Versus Bare Metal Stent Zilver Flex® for Treatment of Lesions in Femoral and Popliteal Arteries in Chronic Limb Threatening Ischemia

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