Is atherectomy the best first-line therapy for limb salvage in patients with critical limb ischemia?

Abstract

Objective: To determine the efficacy of atherectomy for limb salvage compared with open bypass in patients with critical limb ischemia.

Methods: Ninety-nine consecutive bypass and atherectomy procedures performed for critical limb ischemia between January 2003 and October 2006 were reviewed.

Results: A total of 99 cases involving TASC C (n = 43, 44%) and D (n = 56, 56%) lesions were treated with surgical bypass in 59 patients and atherectomy in 33 patients. Bypass and atherectomy achieved similar 1-year primary patency (64% vs 63%; P = .2). However, the 1-year limb salvage rate was greater in the bypass group (87% vs 69%; P = .004). In the tissue loss subgroup, there was a greater limb salvage rate for bypass patients versus atherectomy (79% vs 60%; P = .04).

Conclusions: Patients with critical limb ischemia may do better with open bypass compared with atherectomy as first-line therapy for limb salvage.

Figure 1

Survival curve showing the difference in survival between groups.

Figure 2

Primary, primary assist and secondary patency curves were determined using Kaplan-Meier survival curves. Cumulative patency up to a 1-year time point was determined with a standard error (SE) less than 0.10. Results for infrainguinal bypass versus atherectomy were compared by log rank analysis.

Figure 3

A significant increase in ankle brachial indexes (ABIs) was noted in patients treated by open bypass compared with those treated by atherectomy (*P < .05).

Figure 4

A, Kaplan-Meier survival curves illustrating a significant difference in the 1-year limb salvage rates between infrainguinal bypass patients and atherectomy patients. B, The 1-year limb salvage rates were also significantly different between groups when considering strictly femoral-popliteal lesions.

Figure 5

Subgroup analysis of open bypass versus atherectomy for patients treated specifically for tissue loss.