Endovascular Repair of Peripheral Arterial Disease

Abstract

Objective

One thousand consecutive patients who underwent endovascular repair in an 8-year period were studied retrospectively to evaluate technical success, freedom from reinterventions, early clinical outcome, and risk factors for restenosis/occlusion.

Methods

Mean ± SD Rutherford class was 3.29 ± 0.8. A total of 755 patients have claudication, 423 from rest pain, and 569 from ischemic ulceration.

Results

A total of 552 men and 448 women (mean ± SD = 69.84 ± 8 years; range = 19–89 years) underwent endovascular repair. A total of 698 patients received local anesthesia and 302 general anesthesia. A total of 447 patients received percutaneous transluminal angioplasty, 650 stents were placed; 231 atherectomies were performed and 171 patients received hybrid approach. The procedure was successful in 847 patients (84%). There was no early death. There were 151 early occlusions (95 underwent surgery, 56 received stents), 121 dissections (39 underwent surgery, 56 received stents and 26 medical treatment), 32 hematoma, and 13 early leaks. Mean ± SD Rutherford class improved to 3.02 ± 0.9. Freedom from reintervention rate at 8 years was 76%. A total of 63 patients underwent surgery and 59 cellular therapy. A total of 134 finger, 142 below-knee, and 29 above-knee amputations were reported.

Conclusions

Endovascular interventions can be performed with a satisfactory technical success and low complication rates; however, nonfatal complications and catheter-based reinterventions are frequent.

Keywords

Endovascular intervention Percutaneous transluminal angioplasty Angiographic surveillance Peripheral artery disease endovascular

Get full access to this article

View all access options for this article.

References

Sobieszczyk

, Eisenhauer

Management of patients after endovascular interventions for peripheral artery disease. Circulation. 2013; 128: 749–757.

Thukkani

A.K.

, Kinlay

Endovascular intervention for peripheral artery disease. Circ Res. 2015; 24(116): 1599–1613.

Society for Vascular Surgery Lower Extremity Guidelines Writing Group, Conte

M.S.

, Pomposelli

F.B.

, Clair

D.G.

Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: management of asymptomatic disease and claudication. J Vasc Surg. 2015; 61: 2S–41S.

Bishu

, Armstrong

E.J.

Supera self-expanding stents for endovascular treatment of femoropopliteal disease: a review of the clinical evidence. Vasc Health Risk Manag. 2015; 11: 387–395.

Kang

Endovascular approach to iliac artery stenosis and restenosis. Indian Heart J. 2015; 67: 514–517.

Aggarwal

, Waldo

S.W.

, Armstrong

E.J.

Endovascular revascularization for aortoiliac atherosclerotic disease. Vasc Health Risk Manag. 2016; 12: 117–127.

Ahn

, Park

K.M.

, Kim

Y.K.

Outcomes of endovascular treatment for TASC C and D aorto-iliac lesions. Asian J Surg. 2017; 40: 215–220.

Hardman

R.L.

, Jazaeri

, Yi

, Smith

, Gupta

Overview of classification systems in peripheral artery disease. Semin Intervent Radiol. 2014; 31: 378–388.

Diamantopoulos

, Katsanos

Treating femoropopliteal disease: established and emerging technologies. Semin Intervent Radiol. 2014; 31: 345–352.

10.

Jaff

M.R.

, White

C.J.

, Hiatt

W.R.

An update on methods for revascularization and expansion of the TASC lesion classification to include below-the-knee arteries: a supplement to the inter-society consensus for the management of peripheral arterial disease (TASC II): The TASC Steering Comittee(.). Ann Vasc Dis. 2015; 8: 343–357.

11.

Baril

D.T.

, Chaer

R.A.

, Rhee

R.Y.

, Makaroun

M.S.

, Marone

L.K.

Endovascular interventions for TASC II D femoropopliteal lesions. J Vasc Surg. 2010; 51: 1406–1412.

12.

Guo

, Xue

, Huang

Outcomes of endovascular treatment for patients with TASC II D femoropopliteal occlusive disease: a single center study. BMC Cardiovasc Disord. 2015; 15: 44.