Endovascular-first strategy in patients with critical limb ischemia

Hassan Tehrani, Chris Otero, Mariano Arosemena, Eduardo Perez, Kenneth Zelnick, Cesar Mendoza, Jose Yrizarry, Kevin Stadtlander, Gary Rothenberg, Michael Cohen, Karin Zachow, Alan Schob

Research output: Contribution to journalReview article

2 Scopus citations

Abstract

Purpose: To assess outcomes of percutaneous infrainguinal endovascular interventions as the initial therapeutic modality in patients with critical limb ischemia (CLI). Materials and Methods: We performed a retrospective review of 33 consecutive interventions in 29 patients over a period of 24 months at a single center. Mean follow-up was 11.4 months. Technical success was defined as the ability to obtain in-line arterial flow into the foot with less than a 20% residual stenosis using percutaneous techniques. Limb salvage was defined as the ability to avoid major level amputation (below or above knee). Follow-up included clinical examination and noninvasive vascular evaluation by color-flow duplex ultrasound. Results: Thirty-three limbs were treated for disabling claudication (n = 2), rest pain (n = 10) or ulceration/gangrene (n = 21). All patients were male. Technical success was achieved in 31 limbs (93.9%). Intra-procedural complications included clinically significant embolization (n = 2, successfully treated by thrombolysis) and acute respiratory failure (n = 1). Post-procedure complications included puncture site pseudoaneurysm necessitating operative repair (n = 1), and acute renal failure (n = 1). Two patients died within 30 days post-procedure of cardiac related events. Of those patients who had a technically successful procedure, 5 underwent a major level amputation during the follow-up period. The limb salvage rate was 83.9%. Conclusions: An "endovascular-first" strategy can yield good limb salvage rates in patients with advanced lower extremity limb ischemia.

Original languageEnglish (US)
Pages (from-to)380-383
Number of pages4
JournalVascular Disease Management
Volume3
Issue number6
StatePublished - Nov 1 2006

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Tehrani, H., Otero, C., Arosemena, M., Perez, E., Zelnick, K., Mendoza, C., Yrizarry, J., Stadtlander, K., Rothenberg, G., Cohen, M., Zachow, K., & Schob, A. (2006). Endovascular-first strategy in patients with critical limb ischemia. Vascular Disease Management, 3(6), 380-383.