Limb Salvage Rate In Patients Research Articles

The impact of alternative autologous venous material on limb salvage rates in patients with chronic limb-threatening ischemia

The impact of alternative autologous venous material on limb salvage rates in patients with chronic limb-threatening ischemia

Secondary endovascular procedures improve overall patency and limb salvage in patients undergoing in situ saphenous vein infragenicular bypass.

Secondary interventions strongly improves patency and limb salvage rates in patients undergoing infrainguinal vein bypass. The aim of this study was to evaluate the influence of secondary endovascular procedures performed during the follow-up on patency and limb salvage in patients with critical limb-threatening ischemia (CLTI) undergoing in situ saphenous vein infragenicular bypass. From January 2018 to December 2019 541 patients in 43 centers have been enrolled into the LIMBSAVE registry (treatment of critical Limb IschaeMia with infragenicular Bypass adopting in situ SAphenous VEin technique). In all patients a strict surveillance program with Duplex scan was established (1, 3, 6, 9, 12, 18, 24 months). During the follow-up indications for endovascular procedures were anastomotic stenoses, improvement of run-in (iliac stenosis) or run-off (tibial vessels' stenoses or occlusions). Two-year estimated outcomes in terms of overall patency, and limb salvage were analyzed by life-table analysis (Kaplan-Meier test). Outcomes obtained in patients undergoing endovascular procedure (Group-endo) were compared by means of Gehan-Breslow-Wilcoxon Test with those obtained in patients with no secondary endovascular procedure during the follow-up (Group-no endo). Two groups were homogeneous in terms of demographics and intraprocedural details. Overall mean duration of follow-up was 12.1 months (range 1-24). During the follow-up period (>30 days) 55 endovascular procedures were performed in 49 patients (9.1%) (Group-endo). Most of endovascular procedures (37/55, 67.3%) was performed to treat stenoses at proximal or distal anastomosis. Secondary endovascular procedures (40/55, 72.7%) were predominantly performed within 6 months from the index procedure. Estimated 2-year overall patency (97.9% vs. 85.2%, P=0.05), and limb salvage (100% vs. 93.9%, P=0.05) rates were significantly better in Group-endo. Secondary endovascular procedures in patients with CLTI undergoing in situ saphenous infragenicular bypass significantly improve the rates of overall patency and limb salvage in the mid-term period.

Percutaneous transluminal angioplasty associated with a comparable risk of mortality in old patients with severe lower extremities arterial disease

Abstract Background Percutaneous transluminal angioplasty (PTA) improves limb salvage rates in patients with severe lower extremity arterial disease (LEAD). It remains unknown whether PTA can be safely performed to the older LEAD patients. Purpose We investigated the effect of age ≥85 vs <85 years on prognoses in LEAD patients. Methods We analyzed 222 LEAD patients from our previous retrospective cohort study between 2013 and 2018. All patients received percutaneous transluminal angioplasty. Study outcomes were in-hospital mortality and 1-year all-cause mortality and major adverse limb events (MALEs). Results The study included 222 patients aged 74±11 years (54% male), and 12.6% had acute limb ischemia. The older group had significantly higher rates of in-hospital (17.8 vs. 5.1%, P=0.009) and all-cause mortality (37.8% vs. 19.2%, P=0.016), but MALEs were not different significantly (8.9% vs. 16.9%, P=0.247). In multivariate logistic regression analyses, age ≥85 years was not associated with the increased risks of the study outcomes after we adjusted for potential confounders. The risk factors associated with 1-year all-cause mortality was the presence of acute limb ischemia (adjusted HR: 2.978, 95% CI: 1.502–5.905, P=0.002) and Rutherfold stages (adjusted HR: 2.135, 95% CI: 1.248–3.652, P=0.005). Conclusion Compared with the patients aged less than 85 years, the LEAD patients aged more than 85 years had favorable risks of mortality after receiving PTA, and the incident MALEs were not significantly different. Funding Acknowledgement Type of funding sources: None. Study outcomes in LEAD patients

Prevalence, Characteristics, and Prognosis of Peripheral Arterial Disease in Patients With Diabetic Charcot Foot

Charcot foot (CF) is a rare complication of diabetes associated with foot deformities and foot ulcers. Peripheral arterial disease (PAD) is a factor of poor prognosis in patients with diabetic foot ulcers (DFUs). However, PAD has infrequently been studied in CF. We aimed to determine the prevalence, the characteristics and the prognosis of PAD in a large group of patients with diabetic CF. We retrospectively compared 56 patients with diabetic CF to 116 patients with diabetic foot without CF. The prevalence of PAD in patients with CF was 66.1%. Compared to patients without CF, patients with CF had similar risks to have PAD (OR 0.98, 95%CI 0.50-1.94, p= .97) and neuro-ischemic DFUs (OR 1.19, 95%CI 0.57-2.49, p=.65), more risk to have lesions of distal arteries (OR 4.17, 95%CI 1.76-9.94, p=.001) and less risk to need revascularization (OR 0.14, 95%CI 0.06-0.36, p< .001). In patients with CF, PAD was strongly predicted by DFUs (OR 24.55, 95%CI 1.80-334.43, p=.016) and coronary artery disease (OR 17.11, 95%CI 1.75-167.43, p=.015). Survival rate and limb salvage rate in patients with CF were not worsened by PAD and by neuro-ischemic DFUs, respectively. In conclusion, we show that PAD should not be overlooked in patients with diabetic CF, especially in those having DFUs or coronary artery disease. PAD in patients with CF differed from that of patients without CF since it predominated in distal arteries and required less often revascularization.

Outcomes of Pedal Artery Angioplasty Are Independent of the Severity of Inframalleolar Disease: A Subanalysis of the Multicenter RENDEZVOUS Registry

Purpose: To examine the efficacy of pedal artery angioplasty (PAA) for chronic limb-threatening ischemia (CLTI) according to the severity of inframalleolar disease. Methods: In total, 257 consecutive CLTI patients (mean age 73.2 years; 175 men) with de novo infrapopliteal and inframalleolar artery disease were enrolled from the retrospective RENDEZVOUS registry. Inframalleolar artery disease was classified as moderate (Kawarada type 2, 144 patients) or severe (Kawarada type 3, 113 patients). PAA was performed in 140 patients: 66 (45.8%) with moderate disease and 74 (65.5%) with severe disease. The remaining 117 patients (78 with moderate disease and 39 with severe disease) underwent interventions that did not include PAA. The primary outcomes were the wound healing and limb salvage rates at 12 months after the initial treatment. The outcomes of the PAA and no-PAA groups were examined to determine any correlation between treatment efficacy and baseline disease severity. Results: The success rates of PAA among the patients with moderate and severe inframalleolar disease were 89.4% and 87.8%, respectively (p=0.683). The wound healing rate at 12 months was significantly higher in the PAA group than in the no-PAA group regardless of the severity of inframalleolar disease [moderate: 58.8% vs 40.0% (p=0.049); severe: 59.6% vs 33.2% (p=0.021), respectively]. The worst limb salvage rate (76.9%) was seen among patients in the no-PAA group with severe inframalleolar disease (no-PAA/moderate: 94.8%; PAA/moderate: 90.9%; and PAA/severe: 87.8%, p=0.028). Conclusion: PAA improves the wound healing rate of patients with CLTI regardless of the severity of inframalleolar disease. This treatment modality also might improve limb salvage rates in patients with severe inframalleolar disease affecting both the anterior and posterior pedal circulations.

Long-Term Outcomes after Infrainguinal Revascularization in Patients with Critical Limb Ischemia on End-Stage Renal Disease Patients (ESRD) and Comparison Results with Non-ESRD Population

Infrainguinal revascularization in end-stage renal disease patients is controversial, despite of patency and limb salvage rates observed in several studies. This study provides more favourable overall survival and amputation free-survival rates than the contemporary study of the same characteristics. The revascularization of patients with ESRD is frequently conditioned by poor survival. With the data we provide, approximately half of the patients were alived and their limb was salvaged at 3 years, and this is encouraging. Thus, we can be more aggressive in daily practice and offer revascularization in ESRD patients. Objective: This study analyzed long-term outcomes and evaluate the benefits and limits of infrainguinal revascularization (IR) both surgical and endovascular revascularization with critical limb ischemia (CLI) in patients with and without ESRD. Material and Methods: A total of 1188 patients were prospectively collected and analyzed retrospectively. We included 108 (9.1%) patients with ESRD and of them 70 (64.8%) receiving hemodialysis. Results: The 30-day mortality rate was higher in ESRD group (5.6 vs. 1.8, p=0,009). The second patency was similar in both groups at 1 and 3 years (87.6% and 85.3% vs. 82.9% and 81.6%). ESRD patients had a lower overall survival and amputation free-survival (AFS) (at 1 year 79.6% vs. 91.8% and at 3 years 57.9% vs. 79.1%, p<0.001) and (at 1 year 68.2% vs. 78.8% and at 3 years 45.7% vs. 64.6%, p<0,001) than non- ESRD patients. The limb salvage rates achieved excellent outcomes during follow-up at 1 and 3 years. (83.5% and 83.2% vs. 66.0% and 77.6% (p=0.194). Cox regression analysis showed that hemodialysis was an independent predictor of all-cause mortality and AFS (HR=2.38, 95% CI 1.54- 3.68, p<0,001). Octogenarian patients and coronary disease was independent predictor of all-cause mortality (HR=3.05, 95% CI 2.3-4.01, p<0.001) and (HR=1.49, 95% CI 1.14-1.95, p=0.03). Conclusions: The long-term patency and limb salvage rates in patients who underwent IR with CLI and ESRD was comparable with non- ESRD patients. Despite, the overall survival and amputation free-survival rates was poorer in ESRD patients, we advocated for aggressive revascularization attitude in ESRD patients but we must individualize treatment decision and should be offered revascularization for patients with acceptable life expectancy.

A comparative study of postrevascularization limb salvage rate in early versus delayed presentation of rutherford class IIb acute lower extremity ischemia

Background: Acute limb ischemia (ALI) is the most common vascular emergency with potential morbidity and mortality, which can be prevented by early appropriate treatment. Delayed presentation because of diagnostic delays and referrals continues to be a challenge for vascular surgeons. The purpose of this study is to evaluate the postrevascularization limb salvage rate in patients with delayed presenting ALI Rutherford Class IIb and compare it with early presenting ALI in a tertiary referral center in India. Materials and Methods: Fifty-one patients with Rutherford Class IIb acute lower limb ischemia, who underwent revascularization over a period of 2 years from June 2015 to May 2017 at Jain Institute of Vascular Sciences, Bengaluru, were evaluated in this study. Patients were divided into early presenting (<24 h) (n = 10) and delayed presenting (>24 h–14 days) (n = 41), and both the groups were compared with respect to limb salvage at 1 year. Patients with prior vascular intervention, posttraumatic ALI, and Rutherford Class I, IIa, and III were excluded. Results: Both the groups were comparable with respect to demographics, lesion characteristics, and comorbidities. The mean age in the early and delayed presenting groups was similar. Majority of the patients were male. The most common level of occlusion was femoropopliteal segment. All patients underwent transfemoral/transpopliteal thrombectomy + angioplasty/stenting. Fasciotomy was performed in almost half of the patients based on clinical need. The limb salvage rate was 91.67% in the early presenting group, whereas in the delayed presenting group, it was 72.73%, but the difference was not statistically significant (P = 0.178). None of the patients in the early presenting group had morality, whereas it was 12.20% in the delayed group, which was statistically not significant (P = 0.249). Conclusion: In patients with Rutherford Class IIb ALI in spite of delayed presentation, good limb salvage rate can be achieved if revascularized.

Limb Salvage Does Not Predict Functional Limb Outcome after Revascularization for Traumatic Acute Limb Ischemia

Traumatic vascular injury leading to acute limb ischemia (ALI) is an uncommon problem with a potential for high morbidity. We describe a contemporary series of patients with traumatic ALI managed primarily by vascular surgeons at a tertiary referral center and review factors associated with limb salvage and functional limb outcomes. We conducted a single institution, retrospective review of all patients requiring revascularization for upper extremity (UE) and lower extremity (LE) ALI secondary to trauma from 2013 to 2016. Demographic data, transfer timing, injury severity score (ISS), Rutherford classification (RC), preoperative imaging, level of occlusion, procedural information, fasciotomy characteristics, and discharge disposition were reviewed. Outcome measures included limb salvage and functional limb outcomes. We identified 68 patients with traumatic ALI requiring revascularization. The majority of patients had moderate ISS scores, were RC 2a or 2b on presentation (65%), were transferred from another institution (53%), and underwent preoperative imaging (62%) with expeditious time to operation (median 4.5hr). The most common location of vascular injury for UE was axillary-brachial (88%) and for LE was femoral-popliteal (69%). Open vascular procedures dominated the treatment strategy, and the median number of operations was 3. Fasciotomy was performed in 25% of UE and 58% of LE injuries. Shunts were utilized in only 2 patients. Overall LS was 94% for UE and 78% for LE. The median length of stay (LOS) was 11days, with 25% of patients discharged to a skilled nursing facility. Follow-up was obtained for 59% of patients. For UE injuries, 57% of patients had no or minimal functional deficits, while 33% had major functional deficits and 10% underwent amputation. For LE injuries, 68% of patients had no or minimal functional deficits, while 6% had major functional deficits, and 26% had undergone amputation. Rutherford class and the number of operations performed were independent predictors of amputation and functional limb at follow-up in our logistic regression model (P<0.05). Revascularization for traumatic ALI yields high limb salvage rates in patients with RC 1 and 2 ischemia and patients with UE injuries. However, limb salvage does not necessarily equate to good functional outcomes. This signifies the complex nature of injuries in this patient population, especially when multiple operations are required.

Cryopreserved Allografts for Treatment of Chronic Limb-Threatening Ischemia in Patients Without Autologous Saphenous Veins

Revascularization is the best alternative to reduce symptoms and to improve the limb salvage rate in patients with chronic limb-threatening ischemia (CLI). Alternative grafts as synthetic prostheses and allografts must be considered for patients without a suitable autologous graft. Our aim was to evaluate outcomes of cryopreserved allografts used as a vascular conduit for bypass surgery in the infrainguinal territory. A retrospective analysis (January 1995 to January 2014) of the Registry of vascular and valvular allografts transplant in the autonomous community of Catalonia, Spain was performed for identifying patients with CLI who required infrainguinal bypass with cryopreserved arterial allografts. Statistical analysis was performed using SPSS, ver. 20, for Mac (Chicago). A total of 149 patients with CLI (mean age of 70.1years) were analyzed. One hundred two patients (68.5%) had a grade IV lesion (Fontaine classification). In the overall follow-up, 24.8% of patients required a reintervention. Overall graft occlusion, infection, and dilation rate were 52.3%, 6%, and 5.4% respectively. Overall 30-day mortality was 0.7%. Five-year primary patency rate and limb salvage rate were 38.6% and 50.2%, respectively. Survival rate at 5years was 54.2%. Major adverse limb event (MALE)-free rate was 21.5% at 5years. Revascularization to a distal target vessel was an independent positive predictive risk factor for a lower limb salvage rate and lower primary patency rate. Dyslipidemia was related to a lower limb salvage rate and represents a risk factor involved in MALEs. Although arterial allografts seem to represent a suboptimal alternative, some selected patients could beneficiate from them. Five-year results are disappointing, and more studies are required to know other predictive factors for better selection of patients.

Effects of Perioperative Venous Thromboembolism on Outcomes in Soft Tissue Reconstruction of Traumatic Lower Extremity Injuries.

Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, represents a significant perioperative complication. However, the outcomes of lower extremity salvage in the setting of perioperative VTE are not well reported. A retrospective review of lower extremity trauma patients requiring soft tissue reconstruction between July 2007 and December 2015 at an urban trauma center was performed. Patients with clinically apparent VTE during inpatient stay were identified. Outcomes compared included success of limb salvage, flap survival, and flap complications. Comorbidities, injury characteristics and perioperative data were also compared between patients with and without VTE. One hundred ninety patients with lower extremity injuries underwent local and free flap procedures, with 12 (6.3%) patients developing clinically apparent VTE during hospitalization. Nine VTEs (75.0%) were diagnosed prior to soft tissue reconstruction, and 3 (25.0%) VTEs were diagnosed postreconstruction. The limb salvage rate in patients with VTE was 100%. There were no flap losses in patients with VTE, and the overall flap complication rate was similar between VTE and non-VTE groups (P = 0.26). However, there was an increased risk of postoperative hematoma in patients undergoing free flap transfer with diagnosed VTE compared with patients receiving free flaps without VTE (40.0% vs 2.6%, P = 0.02). Additionally, 1 patient died as a result of pulmonary embolism, and another patient experienced an ischemic stroke from a paradoxical embolism. These results suggest that successful limb salvage and flap survival may be achieved in the setting of perioperative VTE, although anticoagulation prophylaxis and treatment are critical in this population due to significant morbidity and mortality associated with VTE.

04:03 PM Abstract No. 20 Impact of race in limb salvage rates in critical limb ischemia patients undergoing below-knee interventions

To evaluate impact of race in limb salvage rate of patients with critical limb ischemia undergoing below the knee revascularization interventions. A retrospective review of all patients who underwent below the knee arterial revascularization interventions between January 2012 and September 2018 was performed. Demographics such as age, sex, race and ethnicity were assessed with comorbidities including hypertension, diabetes, dyslipidemia and smoking status. Population was grouped in race and ethnicity (White, African American (AA) and Hispanic) according to patient self-identification and limb salvage rates for each group was evaluated. All below the knee interventions were reviewed for technical success rates defined as successful creation of inline flow to the wound. Follow up duration and limb salvage rates were determined for all cases. Comparison of each race and ethnicity group in terms of technical success and clinical outcome was made using Chi Square test with SPSS software. We identified 393 patients who underwent percutaneous arterial revascularization, 201 males and 192 females with mean age of 69.08 years (range 34-98). Mean follow up duration was 2.3 years (1 month to 5.8 years) Out of the total population, 365 patients (92.9%) had hypertension, 262 (66.7%) were diabetic, 246 (62.6%) had dyslipidemia and 271 (68.9%) had a less than 5-year without smoking history. Technical success rates in each group was also not statistically significant with 88.8 in AAs, 78.9% in Hispanics, and 89.7% in Whites) Limb salvage rates showed no significant difference (p-value 0.256) among the groups, AA (70.7%), Hispanic (84.2%) and White population (74.1%). In our study limb salvage rates in patients with critical limb ischemia undergoing below the knee interventions is not impacted by race or ethnicity in contrast to what was published in the literature. We believe existing publications claiming poorer outcomes in African American and Hispanic populations may have institutional and/or geographical biases and larger studies need to be conducted for more definitive conclusions.

Limb Salvage After Percutaneous Mechanical Thrombectomy in Patients with Acute Lower Limb Ischemia: A Retrospective Analysis from Two Institutions

To evaluate the short-term outcomes of percutaneous mechanical thrombectomy (PMT) in patients with acute lower limb ischemia (ALI) and to analyze the effect of ALI of different etiologies on the limb salvage. From January 2015 to December 2017, a retrospective analysis was performed on 112 patients (mean age: 66.5 years; 117 limbs in total; 66 limbs in 61 males) with ALI treated with PMT at 2 vascular institutions. Of the 117 limbs, 44 (41 patients) had acute arterial embolism, 36 (34 patients) had acute arterial thrombosis, and 37 (37 patients) had acute stent (31 limbs in 31 patients) or graft (6 limbs in 6 patients) thrombosis. The primary end point was limb salvage rate, and subgroups were analyzed by etiological factors. The secondary end points included patency rates, major bleeding complications, 30-day mortality, and reintervention rates. The 30-day mortality rate was 3.6%. The incidence of major bleeding complications was 2.7%. During the follow-up, the limb salvage rates at 1year and 2years were 83.8% and 74.7%, respectively. Subgroup analysis showed that the limb salvage rate in patients with acute arterial embolism was 92.9% at 2years after PMT, which was higher than that in patients with acute arterial thrombosis (73.3%, P=0.04, hazard ratio [HR]: 3.6, 95% confidence interval [CI]: 1.1-11.7) and acute stent/graft thrombosis (62.5%, P=0.01, HR: 4.7, 95% CI: 1.5-13.6). PMT in patients with ALI is effective in preventing amputations over the 3-year study period with a reasonable safety profile, especially in patients with acute arterial embolism.

Limb Salvage by Open Surgical Revascularisation in Acute Ischaemia due to Thrombosed Popliteal Artery Aneurysm

Acute ischaemia due to thrombosed popliteal artery aneurysm (PAA) is associated with a high risk of limb loss. The aim of this study was to analyse the outcome, in particular the limb salvage rate in patients undergoing urgent open surgery for acute ischaemia due to thrombosed PAA. This was a retrospective analysis of consecutive patients undergoing urgent open surgery for acute limb ischaemia (Rutherford category≥II) due to thrombosed popliteal artery aneurysm between January 2007 and December 2016at a tertiary referral centre. Fifty-one patients (92% male), median age 75 years (range 46-97 years), were identified. Twenty patients (39%) presented with category IIa acute limb ischaemia, 20 (39%) with category IIb, and 11 (22%) with category III. Four patients (8%) underwent primary major amputation. Forty-seven (92%) underwent bypass surgery, 43/47 (91%) using great saphenous vein. One vessel runoff was present in 27/47 patients (57%). Thirty day mortality was 4% (n=2). Four patients needed major amputation within 30 days, resulting in an overall 30 day major amputation rate of 16% (8/51, 95% confidence interval 7.0-28.6). No further major amputations were necessary during a median follow up of 41 months (range 4-114 months) resulting in an estimated 4 year limb salvage of 84%. The one year primary assisted and secondary bypass patency rates were 90% and 95%, respectively. The estimated four year primary assisted and secondary patency rates were 82% and 87%, respectively. Rapid open surgical revascularisation in patients with acute limb ischaemia due to a thrombosed popliteal artery aneurysm results in good long-term limb salvage rates, especially Rutherford category IIa and IIb acute ischaemia. Revascularisation may be attempted in clinically severe cases not fulfilling all criteria to be classified as category III. Such patients may, in fact, be borderline between IIb and III. Despite poor runoff, good bypass patency rates and low rates of claudication can be achieved.

Editor's Choice – A Prospective Study to Evaluate Complete Wound Healing and Limb Salvage Rates After Angiosome Targeted Infrapopliteal Balloon Angioplasty in Patients with Critical Limb Ischaemia

To evaluate complete wound healing and limb salvage rates in patients with critical limb ischaemia (CLI) with concurrent foot ulceration/gangrene who underwent angiosome targeted infrapopliteal balloon angioplasty. This was a prospective observational study. In total, 212 patients who underwent successful infrapopliteal balloon angioplasty to assist wound healing and achieve limb salvage were included from June 2014 to March 2016. Propensity score matching was developed to compare complete wound healing, 1 year amputation free survival (AFS), and limb salvage rates between the two study groups (direct revascularisation [DR] and indirect revascularisation [IR]). Direct flow to the foot wounds based on the angiosome principle was achieved in 117 legs (55.2%) versus 95 legs (44.8%) that represented the IR group. Seventy-three matched pairs were obtained to minimise intergroup differences in baseline characteristics. Twelve months after angioplasty, the complete wound healing rates were 80.8% and 63.0% (p=.02), AFS rates were 72.6% and 61.6% (p=.164), and limb salvage rates were 90.4% and 82.2% (p=.148) in the DR and IR groups, respectively. This study suggests that the complete wound healing rate is better when the target foot lesion receives direct perfusion following the angiosome concept, whereas limb salvage and AFS rates were not significantly different among the DR and IR groups.

Number of infrapopliteal arteries undergoing endovascular treatment is not associated with the limb salvage rate in patients with critical limb ischemia

The objective of this study was to determine whether the number of infrapopliteal arteries undergoing endovascular treatment is associated with the limb salvage rate in patients with critical limb ischemia (CLI). This was a retrospective, consecutive cohort study of CLI patients who underwent infrapopliteal angioplasty at the Vascular and Endovascular Surgery Service of the Hospital do Servidor Público Estadual, São Paulo, between January 2009 and January 2013. The primary outcome variable was the limb salvage rate. The secondary outcome variables were patency, survival, plantar arch quality, and operative mortality rate. Overall, 109 infrapopliteal angioplasties were performed in 92 patients, and the initial technical success rate was 95.6%. Based on the analyses of the arteriography of the endovascular procedures, the patients were classified into two groups according to whether they had undergone endovascular treatment of one artery (group 1) or two arteries (group2). The mean outpatient follow-up time was 430± 377.5days. The analyses were performed at 180 and 360days. There were 72 angioplasties (66%) in group 1 and 37 (34%) in group 2. Hypertension was more frequent in group 1 (93.1%) than in group 2 (78.4%; P= .03). Other clinical characteristics were similar in both groups. Regarding postoperative complications, the incidence of acute kidney failure was lower in group 1 (0% vs 8.1%, respectively; P= .037). The limb salvage rate at 360days was similar in groups 1 and 2 (89.4% vs 89.3%, respectively; P= .595). The secondary patency rate at 360days was also similar in groups 1 and 2 (59.9% vs 60.9%, respectively; P= .571). The perioperative mortality rate was lower in group 1 (4.2% vs 16.2%, respectively; P= .039), but the survival rate at 360days was similarin both groups (82.1% vs 75.1%, respectively; P= .931). The frequencies of complete, incomplete, and absent plantar arch were similar in both groups. The estimated limb salvage rates for patients with complete plantar arch or incomplete/absent plantar arch were 96.2% and 84.6%, respectively (P= .467), at 360days. Our results suggest that it is not necessary to treat the largest number of arteries possible in CLI patients. Instead, the most amenable artery for endovascular procedures should be treated to improve limb salvage and secondary patency rates.

Treatment results in patients with acute limb ischemia

Aim. Acute limb ischemia (ALI) is one of the most serious subjects for life quality declining and often results in patients’ disability. The incidence of ALI increases from year to year and currently counts about 50 to 100 cases per 100 000 persons in EU and USA.Methods and results. 188 cases were studied, 61% male, 39% female. The average age was 66,8±4,2 years. Among clinical events that caused ALI were atherothrombosis in 90 (47,87%) patients, embolisms in 92 (48,94%) cases, acute thrombosis of bypass graft in 6 (3,19%) patients.Conclusion. Limb salvage rate in patients after complex revascularization surgery was 100%. Thus we can state, that thrombectomy with following one stage angioplasty or bypass grafting improves clinical outcomes and limb salvation rate in patients with ALI.

Endovascular Treatment of Chronic Total Occlusions of the Iliac Arteries: Early and Midterm Results

To examine the effects of endovascular therapy on the treatment of chronic total occlusions (CTOs) of the iliac arteries. We analyzed a cohort of 48 patients (56 limbs) who were treated by endovascular means for iliac artery CTOs during a period of 4 years in 2 vascular surgery centers in Greece. The data were collected retrospectively and were statistically analyzed to report on technical success, morbidity, mortality, primary and secondary patency, and limb salvage through different patient and/or lesion stratifications. Recanalization was accomplished without assisting devices, and primary stenting was always performed. The technical success of the endovascular treatment reached 91%. Patients experienced 4.2% major morbidity and 2.1% mortality rate. Mean ankle-brachial pressure index increased from 0.43 ± 0.12 preoperatively to 0.89 ± 0.11 postoperatively. A median improvement by 3 Rutherford clinical categories was recorded at the first-month follow-up. The estimated limb salvage rate for patients suffering from critical limb ischemia (CLI) was 90.9% at 36 months. Kaplan-Meier analysis estimation for overall primary and secondary patency rate of the treated lesions was 91.4% and 95.3%, respectively at 36 months. There were no statistically significant differences in primary and secondary patency rate between patients in different clinical stages (CLI versus intermittent claudication), as well as between CTO lesions of different Trans-Atlantic Inter-Society Consensus (TASC) categories (TASC B versus TASC C versus TASC D). There was not statistical significant difference between the technical success of TASC B, C, and D lesion groups. The endovascular treatment of iliac CTOs seems to be safe and feasible. The technical success of the procedure could be high, whereas primary and secondary patency rates seem to be optimal, with remarkable limb salvage rate and overall clinical improvement. A potential shift to an endovascular-first approach for such lesions might be currently justified.

Subintimal angioplasty for long (TASC C and D) superficial femoral artery occlusions

Sub-intimal angioplasty (SIA) is a recognized endovascular option for long segment occlusive disease. The Inter-Society Consensus for the Management of peripheral arterial disease (TASC) published a revised classification for infra-inguinal peripheral vascular disease in 2007. We present our experience with this technique and aim to determine the efficacy of sub-intimal angioplasty (SIA) for TASC C and TASC D category lesions. Materials and MethodsA retrospective analysis of all consecutive SIA for TASC C and D superficial femoral artery (SFA) occlusions was conducted. The procedures were carried out in a single center between 01/11/2009 and 01/06/2011. Primary endpoints were limb salvage rates. Secondary endpoints were primary, primary assisted, secondary patency, and complication rates. Kaplan–Meier analysis was used to assess the patency, limb salvage and survival rates. Results29 limbs in 26 patients were treated, median age 69years. Indications included moderate to severe claudication in 18 limbs and critical limb ischemia (CLI) in 11 limbs. There were six TASC C and 23 TASC D lesions with a median lesion length of lesion 27.3cm (15.2–46.4). Complications occurred in 3 cases (10%), which were all distal embolization. All 3 had successful thrombo-aspirations and were treated with IV heparin for 24–48h. The technical and clinical success rates were 93.1%. The primary patency rate, primary assisted patency and secondary patency at 1year of approximately were 41%, 57% and 60% respectively. There was one below knee amputation in the study group, giving a cumulative proportional limb salvage rate of 96.6%. The primary patency of the CLI group was 60% at 1year. ConclusionAlthough we observed a low primary patency rate there were encouraging limb salvage rates in patients with TASC C and D lesions treated with SIA. It provides an alternative to surgery in high risk patients, with acceptable technical success and complication rates but re-intervention is likely to be required.

Effect of Systemic Urokinase Infusion After Lower Limb Percutaneous Transluminal Angioplasty on Limb Salvage Rate in Patients with Late-stage Critical Limb Ischemia

To evaluate the effect of systemically administered urokinase (UK) after percutaneous transluminal angioplasty with or without stent (PTA±stent) on the reduction in the rate and level of amputation in patients with critical limb ischemia (CLI) with tissue loss. This was an observational, nonrandomized, retrospective study of 183 Taiwanese patients with Rutherford stage 5 or 6, and Fontaine stage 4 lower extremity CLI. Patients received either PTA±stent or PTA±stent+UK infusion (250,000IU, daily for 5 days). PTA of the iliac, femoral, anterior tibial artery, posterior tibial artery, and peroneal arteries was included. Amputation was classified as minor, with direct wound healing, and minor amputation or surgical debridement of toes and major, with below- (BKA) and above-knee amputation (AKA). In groups of patients with comparable baseline characteristics, 85 and 90 patients received PTA±stent and PTA±stent+UK, respectively. There were 24 major limb amputations performed. A significant majority (20/24 (83.3%) were performed in patients who did not receive adjuvant urokinase, compared with 4/24 (16.7%) of patients who did receive urokinase (p= 0.000287). There was a significant increase in the limb salvage rate for infrapopliteal lesions in patients treated with PTA+UK (12/72 with UK; 60/72 without UK; p≤.0001). Intracranial hemorrhage (n=1) and bleeding at the inguinal puncture site (n=2) were reported in the PTA±stent+UK group. Eight deaths (one in the PTA±stent+UK group; seven in the PTA±stent) occurred during the study. Systemic administration of UK with the PTA±stent procedure may reduce the requirement for major amputation in patients with CLI with tissue loss (Rutherford 5 or 6). The difference is more pronounced in patients undergoing infrapopliteal interventions. However, these findings need to be confirmed in a randomized prospective study.

8:40 AM Abstract No. 17 - Drug eluting balloons and drug eluting stents in the treatment of peripheral vasculare disease. short and mid-term results

Purpose A prospective study of feasibilty and efficacy of drug eluting balloons (DEB) and drug eluting stents (DES) in the treatment of peripheral vascular disease (PVD) Materials and Methods From September 2009 to July 2012, 191 consecutive patients underwent treatment of PVD using DEB and/or DES. The indications for using DEB/DES were divided into 4 groups: 1) residual stenosis/occlusion after previous therapy (n=116); 2) insufficient result after conventional balloon angioplasty (PTA) and stentimplantation should be avoided (n=19); 3) high risk of residual stenosis in patient suffering from critical limb ischemia (n=53) and 4) miscellaneous (n=3). According to Fontaine classification, 85 patients (45%) had grade 3 or 4 (limb threatening ischemia), and 106 grade 2 (claudicants). All patients were followed-up by physical examination and Doppler sonography and if indicated conventional angiography (DSA). Estimates for the cumulative patency, survival and restenosis rates were calculated by using life table analysis. Results After a mean follow-up of 6 months, residual stenosis (TLR=target lesion region) was seen in 37 patients (20%). Complications were seen in 18 patients (9%), and 4 patients (2%) required surgery. There was no 30-day mortality observed. During follow-up, 13 patients (7%) went to bypass-surgery. The limb salvage rate in patients suffering from limb threatening ischemia was 97% (83/85). Conclusion Using DEB/DES in patients suffering from severe PVD showing complex lesions, gives high immediate and mid-term success rates. Compared to historical data in the literature, the clinical outcome is higher than using conventional methods