Annals of Vascular Surgery
Volume 20, Issue 4 , Pages 440-446, July 2006

Analysis of Outcomes Following Failed Endovascular Treatment of Chronic Limb Ischemia

  • Evan J. Ryer, MD

      Affiliations

    • Division of Vascular Surgery, New York-Presbyterian Hospital, Weill Medical College, Cornell University, New York, NY, USA
    • ,
  • Susan M. Trocciola, MD

      Affiliations

    • Division of Vascular Surgery, New York-Presbyterian Hospital, Weill Medical College, Cornell University, New York, NY, USA
    • ,
  • Brian DeRubertis, MD

      Affiliations

    • Division of Vascular Surgery, New York-Presbyterian Hospital, Weill Medical College, Cornell University, New York, NY, USA
    • Division of Endovascular Surgery, New York-Presbyterian Hospital, College of Physicians and Surgeons, Columbia University, New York, NY, USA
    • ,
  • Russel Lam, MD

      Affiliations

    • Division of Vascular Surgery, New York-Presbyterian Hospital, Weill Medical College, Cornell University, New York, NY, USA
    • Division of Endovascular Surgery, New York-Presbyterian Hospital, College of Physicians and Surgeons, Columbia University, New York, NY, USA
    • ,
  • Robert L. Hynecek, MD

      Affiliations

    • Division of Vascular Surgery, New York-Presbyterian Hospital, Weill Medical College, Cornell University, New York, NY, USA
    • ,
  • John Karwowski, MD

      Affiliations

    • Division of Vascular Surgery, New York-Presbyterian Hospital, Weill Medical College, Cornell University, New York, NY, USA
    • ,
  • Harry L. Bush, MD

      Affiliations

    • Division of Vascular Surgery, New York-Presbyterian Hospital, Weill Medical College, Cornell University, New York, NY, USA
    • ,
  • Leila Mureebe, MD

      Affiliations

    • Division of Endovascular Surgery, New York-Presbyterian Hospital, College of Physicians and Surgeons, Columbia University, New York, NY, USA
    • ,
  • James F. McKinsey, MD

      Affiliations

    • Division of Endovascular Surgery, New York-Presbyterian Hospital, College of Physicians and Surgeons, Columbia University, New York, NY, USA
    • ,
  • Nicholas J. Morrissey, MD

      Affiliations

    • Division of Endovascular Surgery, New York-Presbyterian Hospital, College of Physicians and Surgeons, Columbia University, New York, NY, USA
    • ,
  • K. Craig Kent, MD

      Affiliations

    • Division of Vascular Surgery, New York-Presbyterian Hospital, Weill Medical College, Cornell University, New York, NY, USA
    • Division of Endovascular Surgery, New York-Presbyterian Hospital, College of Physicians and Surgeons, Columbia University, New York, NY, USA
    • ,
  • Peter L. Faries, MD

      Affiliations

    • Division of Vascular Surgery, New York-Presbyterian Hospital, Weill Medical College, Cornell University, New York, NY, USA
    • Corresponding Author InformationCorrespondence to: Peter L. Faries, MD, Division of Vascular Surgery, New York-Presbyterian Hospital, Weill Medical College, Cornell University, 525 E, 68th Street, Room P-705, New York, NY 10021, USA

Despite recent studies highlighting the advantages of endoluminal intervention in the management of chronic limb ischemia (CLI), outcomes following failed peripheral angioplasty remain less well described. We present a retrospective analysis of failed transluminal infrainguinal percutaneous arterial angioplasty with or without stenting (PTA/S) in patients with CLI. A database of patients undergoing infrainguinal PTA/S between 2002 and 2005 was maintained. Patients underwent duplex scanning follow-up at 2 weeks, 3 months, and every 6 months after the intervention. Angiograms were reviewed in all cases to assess lesion characteristics. Results were standardized to current Transatlantic Inter-Society Consensus (TASC) criteria. Kaplan-Meier survival analyses were performed to assess time-dependent outcomes. In total, our analysis involved 246 patients who underwent treatment for CLI using PTA/S. Eighteen percent of procedures (n = 46) were considered an intervention failure secondary to restenosis by duplex ultrasound, returning clinical symptoms, a nonhealing foot lesion, or the absence of a prior palpable pulse. Indications for the original procedure in patients whose PTA/S failed were tissue loss in 44%, claudication in 44%, and rest pain in 12%, while TASC lesion grades were A (0%), B (18%), C (18%), and D (64%). Of patients failing PTA/S, 4% failed in the first 30 days, 78% failed between 1 and 18 months, while 18% failed following 18 months, with a mean time to failure of 8.7 months. Also, 82% of PTA/S failures were candidates for a second endovascular procedure, 11% were suitable for only traditional open bypass, and 4% demonstrated progression of disease necessitating amputation. Of patients undergoing a second endovascular procedure, limb salvage rates were 86% at 12-month follow-up and there was a single periprocedural mortality and complication rate of 6.6%. Of patients requiring open surgical bypass after failed PTA/S, 20% (n = 1) required a major amputation and there were no mortalities. Failure of endoluminal therapy for treatment of lower extremity arterial occlusive disease is amenable to subsequent endovascular intervention for limb salvage with limited morbidity and mortality.

 

 Presented at the Sixteenth Annual Winter Meeting of the Peripheral Vascular Surgery Society.

PII: S0890-5096(06)61459-3

doi:10.1007/s10016-006-9101-4

Annals of Vascular Surgery
Volume 20, Issue 4 , Pages 440-446, July 2006

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