Analysis of outcomes following failed endovascular treatment of chronic limb ischemia

Evan J. Ryer, Susan M. Trocciola, Brian Derubertis, Russel Lam, Robert L. Hynecek, John K Karwowski, Harry L. Bush, Leila Mureebe, James F. McKinsey, Nicholas J. Morrissey, K. Craig Kent, Peter L. Faries

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

Despite recent studies highlighting the advantages of endoluminal intervention in the management of chronic limb ischemia (CLI), outcomes following failed peripheral angioplasty remain less well described. We present a retrospective analysis of failed transluminal infrainguinal percutaneous arterial angioplasty with or without stenting (PTA/S) in patients with CLI. A database of patients undergoing infrainguinal PTA/S between 2002 and 2005 was maintained. Patients underwent duplex scanning follow-up at 2 weeks, 3 months, and every 6 months after the intervention. Angiograms were reviewed in all cases to assess lesion characteristics. Results were standardized to current Transatlantic Inter-Society Consensus (TASC) criteria. Kaplan-Meier survival analyses were performed to assess time-dependent outcomes. In total, our analysis involved 246 patients who underwent treatment for CLI using PTA/S. Eighteen percent of procedures (n = 46) were considered an intervention failure secondary to restenosis by duplex ultrasound, returning clinical symptoms, a nonhealing foot lesion, or the absence of a prior palpable pulse. Indications for the original procedure in patients whose PTA/S failed were tissue loss in 44%, claudication in 44%, and rest pain in 12%, while TASC lesion grades were A (0%), B (18%), C (18%), and D (64%). Of patients failing PTA/S, 4% failed in the first 30 days, 78% failed between 1 and 18 months, while 18% failed following 18 months, with a mean time to failure of 8.7 months. Also, 82% of PTA/S failures were candidates for a second endovascular procedure, 11% were suitable for only traditional open bypass, and 4% demonstrated progression of disease necessitating amputation. Of patients undergoing a second endovascular procedure, limb salvage rates were 86% at 12-month follow-up and there was a single periprocedural mortality and complication rate of 6.6%. Of patients requiring open surgical bypass after failed PTA/S, 20% (n = 1) required a major amputation and there were no mortalities. Failure of endoluminal therapy for treatment of lower extremity arterial occlusive disease is amenable to subsequent endovascular intervention for limb salvage with limited morbidity and mortality.

Original languageEnglish (US)
Pages (from-to)440-446
Number of pages7
JournalAnnals of Vascular Surgery
Volume20
Issue number4
DOIs
StatePublished - Jul 2006
Externally publishedYes

Fingerprint

Ischemia
Extremities
Endovascular Procedures
Limb Salvage
Therapeutics
Amputation
Angioplasty
Mortality
Consensus
Arterial Occlusive Diseases
Kaplan-Meier Estimate
Survival Analysis
Pulse
Disease Progression
Foot
Lower Extremity
Angiography
Databases
Morbidity
Pain

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Ryer, E. J., Trocciola, S. M., Derubertis, B., Lam, R., Hynecek, R. L., Karwowski, J. K., ... Faries, P. L. (2006). Analysis of outcomes following failed endovascular treatment of chronic limb ischemia. Annals of Vascular Surgery, 20(4), 440-446. https://doi.org/10.1007/s10016-006-9101-4

Analysis of outcomes following failed endovascular treatment of chronic limb ischemia. / Ryer, Evan J.; Trocciola, Susan M.; Derubertis, Brian; Lam, Russel; Hynecek, Robert L.; Karwowski, John K; Bush, Harry L.; Mureebe, Leila; McKinsey, James F.; Morrissey, Nicholas J.; Kent, K. Craig; Faries, Peter L.

In: Annals of Vascular Surgery, Vol. 20, No. 4, 07.2006, p. 440-446.

Research output: Contribution to journalArticle

Ryer, EJ, Trocciola, SM, Derubertis, B, Lam, R, Hynecek, RL, Karwowski, JK, Bush, HL, Mureebe, L, McKinsey, JF, Morrissey, NJ, Kent, KC & Faries, PL 2006, 'Analysis of outcomes following failed endovascular treatment of chronic limb ischemia', Annals of Vascular Surgery, vol. 20, no. 4, pp. 440-446. https://doi.org/10.1007/s10016-006-9101-4
Ryer EJ, Trocciola SM, Derubertis B, Lam R, Hynecek RL, Karwowski JK et al. Analysis of outcomes following failed endovascular treatment of chronic limb ischemia. Annals of Vascular Surgery. 2006 Jul;20(4):440-446. https://doi.org/10.1007/s10016-006-9101-4
Ryer, Evan J. ; Trocciola, Susan M. ; Derubertis, Brian ; Lam, Russel ; Hynecek, Robert L. ; Karwowski, John K ; Bush, Harry L. ; Mureebe, Leila ; McKinsey, James F. ; Morrissey, Nicholas J. ; Kent, K. Craig ; Faries, Peter L. / Analysis of outcomes following failed endovascular treatment of chronic limb ischemia. In: Annals of Vascular Surgery. 2006 ; Vol. 20, No. 4. pp. 440-446.
@article{a80d08d49e20457a82291ae3433a6883,
title = "Analysis of outcomes following failed endovascular treatment of chronic limb ischemia",
abstract = "Despite recent studies highlighting the advantages of endoluminal intervention in the management of chronic limb ischemia (CLI), outcomes following failed peripheral angioplasty remain less well described. We present a retrospective analysis of failed transluminal infrainguinal percutaneous arterial angioplasty with or without stenting (PTA/S) in patients with CLI. A database of patients undergoing infrainguinal PTA/S between 2002 and 2005 was maintained. Patients underwent duplex scanning follow-up at 2 weeks, 3 months, and every 6 months after the intervention. Angiograms were reviewed in all cases to assess lesion characteristics. Results were standardized to current Transatlantic Inter-Society Consensus (TASC) criteria. Kaplan-Meier survival analyses were performed to assess time-dependent outcomes. In total, our analysis involved 246 patients who underwent treatment for CLI using PTA/S. Eighteen percent of procedures (n = 46) were considered an intervention failure secondary to restenosis by duplex ultrasound, returning clinical symptoms, a nonhealing foot lesion, or the absence of a prior palpable pulse. Indications for the original procedure in patients whose PTA/S failed were tissue loss in 44{\%}, claudication in 44{\%}, and rest pain in 12{\%}, while TASC lesion grades were A (0{\%}), B (18{\%}), C (18{\%}), and D (64{\%}). Of patients failing PTA/S, 4{\%} failed in the first 30 days, 78{\%} failed between 1 and 18 months, while 18{\%} failed following 18 months, with a mean time to failure of 8.7 months. Also, 82{\%} of PTA/S failures were candidates for a second endovascular procedure, 11{\%} were suitable for only traditional open bypass, and 4{\%} demonstrated progression of disease necessitating amputation. Of patients undergoing a second endovascular procedure, limb salvage rates were 86{\%} at 12-month follow-up and there was a single periprocedural mortality and complication rate of 6.6{\%}. Of patients requiring open surgical bypass after failed PTA/S, 20{\%} (n = 1) required a major amputation and there were no mortalities. Failure of endoluminal therapy for treatment of lower extremity arterial occlusive disease is amenable to subsequent endovascular intervention for limb salvage with limited morbidity and mortality.",
author = "Ryer, {Evan J.} and Trocciola, {Susan M.} and Brian Derubertis and Russel Lam and Hynecek, {Robert L.} and Karwowski, {John K} and Bush, {Harry L.} and Leila Mureebe and McKinsey, {James F.} and Morrissey, {Nicholas J.} and Kent, {K. Craig} and Faries, {Peter L.}",
year = "2006",
month = "7",
doi = "10.1007/s10016-006-9101-4",
language = "English (US)",
volume = "20",
pages = "440--446",
journal = "Annals of Vascular Surgery",
issn = "0890-5096",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - Analysis of outcomes following failed endovascular treatment of chronic limb ischemia

AU - Ryer, Evan J.

AU - Trocciola, Susan M.

AU - Derubertis, Brian

AU - Lam, Russel

AU - Hynecek, Robert L.

AU - Karwowski, John K

AU - Bush, Harry L.

AU - Mureebe, Leila

AU - McKinsey, James F.

AU - Morrissey, Nicholas J.

AU - Kent, K. Craig

AU - Faries, Peter L.

PY - 2006/7

Y1 - 2006/7

N2 - Despite recent studies highlighting the advantages of endoluminal intervention in the management of chronic limb ischemia (CLI), outcomes following failed peripheral angioplasty remain less well described. We present a retrospective analysis of failed transluminal infrainguinal percutaneous arterial angioplasty with or without stenting (PTA/S) in patients with CLI. A database of patients undergoing infrainguinal PTA/S between 2002 and 2005 was maintained. Patients underwent duplex scanning follow-up at 2 weeks, 3 months, and every 6 months after the intervention. Angiograms were reviewed in all cases to assess lesion characteristics. Results were standardized to current Transatlantic Inter-Society Consensus (TASC) criteria. Kaplan-Meier survival analyses were performed to assess time-dependent outcomes. In total, our analysis involved 246 patients who underwent treatment for CLI using PTA/S. Eighteen percent of procedures (n = 46) were considered an intervention failure secondary to restenosis by duplex ultrasound, returning clinical symptoms, a nonhealing foot lesion, or the absence of a prior palpable pulse. Indications for the original procedure in patients whose PTA/S failed were tissue loss in 44%, claudication in 44%, and rest pain in 12%, while TASC lesion grades were A (0%), B (18%), C (18%), and D (64%). Of patients failing PTA/S, 4% failed in the first 30 days, 78% failed between 1 and 18 months, while 18% failed following 18 months, with a mean time to failure of 8.7 months. Also, 82% of PTA/S failures were candidates for a second endovascular procedure, 11% were suitable for only traditional open bypass, and 4% demonstrated progression of disease necessitating amputation. Of patients undergoing a second endovascular procedure, limb salvage rates were 86% at 12-month follow-up and there was a single periprocedural mortality and complication rate of 6.6%. Of patients requiring open surgical bypass after failed PTA/S, 20% (n = 1) required a major amputation and there were no mortalities. Failure of endoluminal therapy for treatment of lower extremity arterial occlusive disease is amenable to subsequent endovascular intervention for limb salvage with limited morbidity and mortality.

AB - Despite recent studies highlighting the advantages of endoluminal intervention in the management of chronic limb ischemia (CLI), outcomes following failed peripheral angioplasty remain less well described. We present a retrospective analysis of failed transluminal infrainguinal percutaneous arterial angioplasty with or without stenting (PTA/S) in patients with CLI. A database of patients undergoing infrainguinal PTA/S between 2002 and 2005 was maintained. Patients underwent duplex scanning follow-up at 2 weeks, 3 months, and every 6 months after the intervention. Angiograms were reviewed in all cases to assess lesion characteristics. Results were standardized to current Transatlantic Inter-Society Consensus (TASC) criteria. Kaplan-Meier survival analyses were performed to assess time-dependent outcomes. In total, our analysis involved 246 patients who underwent treatment for CLI using PTA/S. Eighteen percent of procedures (n = 46) were considered an intervention failure secondary to restenosis by duplex ultrasound, returning clinical symptoms, a nonhealing foot lesion, or the absence of a prior palpable pulse. Indications for the original procedure in patients whose PTA/S failed were tissue loss in 44%, claudication in 44%, and rest pain in 12%, while TASC lesion grades were A (0%), B (18%), C (18%), and D (64%). Of patients failing PTA/S, 4% failed in the first 30 days, 78% failed between 1 and 18 months, while 18% failed following 18 months, with a mean time to failure of 8.7 months. Also, 82% of PTA/S failures were candidates for a second endovascular procedure, 11% were suitable for only traditional open bypass, and 4% demonstrated progression of disease necessitating amputation. Of patients undergoing a second endovascular procedure, limb salvage rates were 86% at 12-month follow-up and there was a single periprocedural mortality and complication rate of 6.6%. Of patients requiring open surgical bypass after failed PTA/S, 20% (n = 1) required a major amputation and there were no mortalities. Failure of endoluminal therapy for treatment of lower extremity arterial occlusive disease is amenable to subsequent endovascular intervention for limb salvage with limited morbidity and mortality.

UR - http://www.scopus.com/inward/record.url?scp=33748610293&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33748610293&partnerID=8YFLogxK

U2 - 10.1007/s10016-006-9101-4

DO - 10.1007/s10016-006-9101-4

M3 - Article

VL - 20

SP - 440

EP - 446

JO - Annals of Vascular Surgery

JF - Annals of Vascular Surgery

SN - 0890-5096

IS - 4

ER -