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Italian Journal of Vascular and Endovascular Surgery 2021 December;28(4):95-104

DOI: 10.23736/S1824-4777.21.01476-5


language: English

Two decades of peripheral arterial disease intervention in a tertiary vascular referral center

Mohamed ELSHERIF 1, Mohamed ELSHARKAWI 1, Wael TAWFICK 2, Baker GHONEIM 1, 3, Niamh HYNES 1, 2, Sherif SULTAN 1, 2

1 Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Galway, Ireland; 2 Galway Clinic, Royal College of Surgeons of Ireland, National University of Ireland Affiliated Teaching Hospital, Doughiska, Galway, Ireland; 3 Department of Vascular Surgery, Cairo University Hospitals, Cairo, Egypt

BACKGROUND: Peripheral arterial disease (PAD) carries high risk of mortality and morbidity. There is still lack of evidence regarding the first line treatment of this disease. We aim to assess and review the outcomes of five different strategies for patients with critical limb ischemia and life limiting claudication.
METHODS: All patients who underwent primarily endovascular therapy (ET), bypass (BS), common femoral artery endarterectomy (CFE), sequential pneumatic compression (SPC) and primary major amputation (PMA) were included. Clinical improvement: patency rates, further interventions and amputation-free survival (AFS) were recorded.
RESULTS: From 2002 to 2019, 623 patients (4.1%) had a diagnosis of critical limb ischemia and life-limiting claudication patients who failed medical therapy. Two hundred and thirteen patients (34%) underwent ET, 77 patients (12%) underwent BS at different levels using different conduits, 66 patients (11%) underwent CFE, 187 patients (30%) were treated with SPC home therapy, and 80 patients (13%) underwent PMA. Demographics were comparable. Technical success was achieved in 96.7% of ET, 96.1% of BS, 90.9% of CFE and 88.6% of PMA (P=0.004). At five-years follow-up, primary patency was 52% in ET, 57% in BS, 81% in CFE patients. Secondary patency was 70% in ET, 66% in BS, and 87% in CFE. Amputation-free survival was 90% in ET, 90% in BS, 87% in CFE, and 77% in SPC at five-years (P=0.866). The overall survival was significantly lower at five years for SPC at 21% and 22% in PMA.
CONCLUSIONS: Amputation-free survival was comparable amongst all groups. Endovascular therapy is still a favorable approach in high-risk patients.

KEY WORDS: Ischemia; Endovascular procedures; Coronary artery bypass; Femoral artery; Endarterectomy; Intermittent pneumatic compression devices

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