Impact of Endovascular Surgery on Management of Critical Lower-Limb Ischemia in a Vascular Surgery Department

• Published in: Vascular and endovascular surgery 2005-09, Vol.39 (5), p.429-435
• Main Authors: Heredero, A. F., Acín, Francisco, March, J. R., Utrilla, F.
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Emergency and intensive care: renal failure. Dialysis management; Female; Femoral Artery - pathology; Femoral Artery - surgery; Follow-Up Studies; Humans; Intensive care medicine; Ischemia - surgery; Lower Extremity - blood supply; Lower Extremity - pathology; Lower Extremity - surgery; Male; Medical sciences; Popliteal Artery - pathology; Popliteal Artery - surgery; Retrospective Studies; Risk Factors; Severity of Illness Index; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery Department, Hospital; Survival Analysis; Treatment Outcome; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Vascular Surgical Procedures - adverse effects
• ISSN: 1538-5744; 1938-9116
• DOI: 10.1177/153857440503900508

The authors analyzed the impact of introduction of endovascular techniques on management and evolution of critical ischemia (CI) in an Angiology and Vascular Surgery department. This is a retrospective review of patients admitted for CI during 2 2-year periods (A: January 1997–December 1998 and B: January 2000–December 2001) differentiated by introduction of endovascular techniques in 1999. Demographic data, clinical symptoms, treatment used, and evolution were recorded and compared between the 2 periods. Survival and limb salvage were analyzed by life tables and compared by log-rank test. One hundred and ninety-three admissions (limbs) for CI were recorded in period A and 226 admissions (limbs) in period B, with no differences in terms of age, sex, clinical severity, or region affected. The distribution of the treatments used in groups A, B, and group B with exclusion of endovascular techniques (B*), was as follows: revascularization (A: 67.4%; B: 50%; B*: 65%); endovascular (A: 0%; B: 23%; B*: 0%); primary amputation (A: 11.4%; B: 11.1%; B*: 14%); conservative (A: 21.2%; B: 15.9%; B*: 21%). Excluding the endovascular procedures, there were no differences between periods as regards the type of treatment or the surgical technique used. There were no differences in early mortality or complication rates. Long-term survival was significantly better in periods B and B* than in period A (p