Résultats à long terme de la chirurgie endovasculaire à l'étage infra-inguinal dans le cadre de l'ischémie critique

Abstract

Study aim Endovascular surgery can be proposed as an alternative to infrainguinal conventional surgery in critical ischemia. The aim of this study was to report the latest results of our series of 186 patients. Materials and methods One hundred and eighty-six patients (100 women and 86 men; mean age 74.5 ± 13 years) were treated for pain during rest (31.5%), gangrene (58%), or ischemic ulcer (10.5%). The lesions were unilateral ( n = 172) or bilateral ( n = 14). Two hundred eighty-seven target lesions were treated: for stenosis ( n = 168) or occlusion ( n = 119): of superficial femoral artery (31.7%), popliteal artery (40%) ortibial arteries (28.3%). Results Technical success was achieved in 81% (15% amputations). The in-hospital mortality rate was 6.5%. The cumulative patency rate was 61 ± 3% at 12 months, and 52 ± 6% at 48 months. The limb salvage rate was 87 ± 3% at 12 months and 82 ± 4% at 48 months. Thirteen potential factors of patency were analyzed: the only predictive factors affecting patency were occlusion versus stenosis, and the use of atherectomy (Log rank test: P < 0.001 and P < 0.0001). Conclusion Despite a risk of technical failure and of midterm restenosis, endovascular surgery for critical ischemia provides a fair long-term limb salvage rate.