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Vol 19, No 1 (2013)
Research paper
Published online: 2013-04-10

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Safety and efficacy of endovascular treatment of chronic ischemia of the lower limbs in 6-months follow-up

Łukasz Drelicharz, Andrzej Belowski, Marek Krzanowski, Tomasz Kułaga, Rafał Niżankowski
Acta Angiologica 2013;19(1):18-35.

Abstract

INTRODUCTION: The aim of the study was to provide data on the safety and efficacy of endovascular treatment of peripheral arterial occlusive disease (PAOD).

MATERIAL AND METHODS: Data recorded prospectively in the Małopolska Endovascular Registry related to all endovascular procedures performed in a single interventional angiology unit within a year (2010/2011) were analysed. The rate of serious adverse events (SAE — death, stroke, ACS, amputation, urgent surgery, endovascular reintervention, severe heart failure) was assessed at 1 month after treatment. Degree of ischemia, quality of life and adverse events were monitored up to 6 months. Exacerbation of ischemia by at least 1 stage of the Rutherford classification, above the ankle amputation of the treated leg or reintervention (surgical or endovascular) within the treated region were regarded as failure of primary procedure while an increase by at least 1 Rutherford category without reintervention was regarded as a primary success of treatment.

RESULTS: A total of 980 procedures were performed to treat 833 limbs (41.6% cases with critical limb ischemia [CLI]). Good angiographic result was seen in over 95% of cases. Up to 1 month 1.5% of CLI patients died and there were no death in claudicants, the SAE rate was low (6.9% in CLI v. 1.3% in non-CLI, p < 0.001). At 6 month follow-up the rate of amputation-free survival was 86.2% in CLI and 98.4% in non-CLI patients (p < 0.001). Primary success was noted in 71.5% (83.7% non-CLI and 54% in CLI; p < 0.001). A significant improvement of the quality of life and improvement of ABI was observed (0.5 ± 0.33 v. 0.8 ± 0.34, p < 0.01); 7% of CLI and 1.2% of non-CLI patients died (p < 0.001), amputation rate was low (7.6% in CLI v. 0.2% in non-CLI patients). There was significantly more reinterventions in the CLI (11.1% v. 2.4%; p = 0.002). An increase in the severity of ischemia was noted in another 2.3% of CLI and 0.6% of non-CLI limbs (p < 0.001). 94% of patients did not require reintervention.

CONCLUSIONS: Endovascular therapy is quite safe and effective in PAOD treatment. While the results were significantly worse in CLI than claudicants, endovascular treatment seems to be particularily suitable for CLI

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