Does preferential use of endovascular interventions by vascular surgeons improve limb salvage, control of symptoms, and survival of patients with critical limb ischemia?

Abstract

Background Our approach to patients with critical limb ischemia (CLI) underwent a rapid evolution from open surgery to preferential use of endovascular procedures. The goal of the current report was to evaluate the impact of this change on patients with CLI. Methods Consecutive patients with CLI were compared between 3 periods: June 2001 to October 2002 (I) versus November 2002 to October 2003 (II) versus November 2003 to June 2005 (III). Results A total of 275 patients (301 limbs, mean age 70 ± 11) underwent revascularization or primary major amputation (PA) for CLI (81 in I, 76 in II, 144 in III). PA decreased from 14.8%, 10.5%, and 3.5% ( P < .001). Mean follow-up was 19.7 ± 13.6 months (range 0 to 57). Overall 24-month limb salvage (LS) was 60%, 69%, and 85% ( P = .001), and 71%, 77%, and 88% following LS attempt ( P = .017), with no difference in survival. Length of stay (LOS) decreased from 10.7 ± 12.1 (I) to 5.2 ± 6.2 days (III) ( P = .001). Conclusions Preferential use of endovascular interventions in patients presenting with CLI resulted in decreased number of PA, improved LS, and decreased LOS, without a difference in survival.