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Real life outcomes of infrapopliteal endovascular and surgical bypass intervention for chronic limb threatening ischaemia in GLASS stages II and III
Rossi, Fabio Henrique; Giusti, Júlio César Gomes; Cury, Marcus Vinicius Martins; Beraldo, João Paulo Neves; Brochado Neto, Francisco Cardoso; Kambara, Antonio Massamitsu.
Afiliación
  • Rossi, Fabio Henrique; Department of Vascular and Endovascular Surgery, Instituto Dante Pazzanese de Cardiologia. São Paulo. BR
  • Giusti, Júlio César Gomes; Department of Vascular Surgery, Hospital Municipal Dr. Carmino Caricchio. São Paulo. BR
  • Cury, Marcus Vinicius Martins; Department of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual. São Paulo. BR
  • Beraldo, João Paulo Neves; Department of Vascular Surgery, Hospital Municipal Dr. Carmino Caricchio. São Paulo. BR
  • Brochado Neto, Francisco Cardoso; Department of Vascular Surgery, Hospital Municipal Dr. Carmino Caricchio. Department of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual. São Paulo. BR
  • Kambara, Antonio Massamitsu; Department of Vascular and Endovascular Surgery, Instituto Dante Pazzanese de Cardiologia. São Paulo. BR
Eur. j. vasc. endovasc. surg ; 64(1)July 2022.
Article en En | CONASS, SES-SP, SESSP-IDPCPROD, SES-SP | ID: biblio-1378091
Biblioteca responsable: BR79.1
ABSTRACT
OBJETIVE Great efforts have been made to determine when choosing between bypass surgery or angioplasty as first-time revascularization in chronic limb-threatening ischemia (CLTI). Endovascular therapy predominates despite limited evidence for their advantage. The purpose of this observational cohort study, was to investigate outcomes after open and endovascular infrapopliteal revascularization in extensive infrainguinal arterial disease.

METHODS:

The medical records of 1427 patients who underwent infrainguinal revascularization exclusively for CLTI in the period of January 2014 to February 2019 were reviewed. After detailed analysis, only infrapopliteal revascularizations classified as GLASS stage II or III were considered, resulting in 326 procedures. There were 127 patients who underwent endovascular therapy and 199 patients who underwent bypass graft surgery (BGS). The primary endpoints included amputation-free survival (AFS) and overall survival (OS). Secondary endpoints included the analyses of multiple factors related to long-term AFS.

RESULTS:

Regarding the primary endpoint, AFS were 75.2% and 65.2% at 1 and 3 years, respectively. Overall survival at 1 and 3 years were 91.2% and 83.1%, respectively. In the univariate analysis, the hazard of the combined endpoint of major amputation or death was higher following bypass surgery than after endovascular therapy (HR 1.80; 95% CI, 1.13-2.89; P= .013). After either revascularization method, TASCII femoropopliteal D was associated with a higher risk of amputation or death (HR 1.69; 95% CI, 1.10-2.58; P= .015). Multivariate Cox regression analysis revealed no association between the variables analysed for AFS.

CONCLUSIONS:

CLTI patients submitted to infrapopliteal revascularization and classified as GLASS II and III had satisfactory AFS and OS rates after indivualized team conference decision. Furthermore, the revascularization modality (endo or open) did not influence the results of AFS.
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Colección: 06-national / BR Base de datos: CONASS / SES-SP / SESSP-IDPCPROD Asunto principal: Puente de Arteria Coronaria / Procedimientos Endovasculares / Isquemia Crónica que Amenaza las Extremidades Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Idioma: En Revista: Eur. j. vasc. endovasc. surg Año: 2022 Tipo del documento: Article
Buscar en Google
Añadir a Mi BVS
Imprimir
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Colección: 06-national / BR Base de datos: CONASS / SES-SP / SESSP-IDPCPROD Asunto principal: Puente de Arteria Coronaria / Procedimientos Endovasculares / Isquemia Crónica que Amenaza las Extremidades Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Idioma: En Revista: Eur. j. vasc. endovasc. surg Año: 2022 Tipo del documento: Article