Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2015 Nov 24;132(21):1999-2011.
doi: 10.1161/CIRCULATIONAHA.114.013440. Epub 2015 Sep 11.

The Contemporary Safety and Effectiveness of Lower Extremity Bypass Surgery and Peripheral Endovascular Interventions in the Treatment of Symptomatic Peripheral Arterial Disease

Thomas T Tsai  1 , Thomas F Rehring  2 , R Kevin Rogers  2 , Susan M Shetterly  2 , Nicole M Wagner  2 , Rajan Gupta  2 , Omid Jazaeri  2 , Nasim Hedayati  2 , W Schuyler Jones  2 , Manesh R Patel  2 , P Michael Ho  2 , Alan S Go  2 , David J Magid  2
Affiliations
Multicenter Study

The Contemporary Safety and Effectiveness of Lower Extremity Bypass Surgery and Peripheral Endovascular Interventions in the Treatment of Symptomatic Peripheral Arterial Disease

Thomas T Tsai et al. Circulation. .

Abstract

Background: Treatment for symptomatic peripheral artery disease includes lower extremity bypass surgery (LEB) and peripheral endovascular interventions (PVIs); however, limited comparative effectiveness data exist between the 2 therapies. We assessed the safety and effectiveness of LEB and PVI in patients with symptomatic claudication and critical limb ischemia.

Methods and results: In a community-based clinical registry at 2 large integrated healthcare delivery systems, we compared 883 patients undergoing PVI and 975 patients undergoing LEB between January 1, 2005 and December 31, 2011. Rates of target lesion revascularization were greater for PVI than for LEB in patients presenting with claudication (12.3±2.7% and 19.0±3.5% at 1 and 3 years versus 5.2±2.4% and 8.3±3.1%, log-rank P<0.001) and critical limb ischemia (19.1±4.8% and 31.6±6.3% at 1 and 3 years versus 10.8±2.5% and 16.0±3.2%, log-rank P<0.001). However, in comparison with PVI, LEB was associated with increased rates of complications up to 30 days following the procedure (37.1% versus 11.9%, P<0.001). There were no differences in amputation rates between the 2 groups. Findings remained consistent in sensitivity analyses by using propensity methods to account for treatment selection.

Conclusions: In patients with symptomatic peripheral artery disease, in comparison with LEB, PVI was associated with fewer 30-day procedural complications, higher revascularization rates at 1 and 3 years, and no difference in subsequent amputations.

Keywords: comparative effectiveness research; lower extremity bypass surgery; peripheral arterial disease.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Cumulative incidence by indication and procedure type. Peripheral endovascular intervention, solid line (95% CI dotted lines); lower extremity bypass, long dashed lines (95% CI smaller dashed lines); and unadjusted cumulative incidence using Kaplan-Meier survival models. CI indicates confidence interval; and CLI, chronic limb ischemia.
Figure 2.
Figure 2.
Cumulative incidence by indication and procedure type. Peripheral endovascular intervention, solid line (95% CI dotted lines); lower extremity bypass, long dashed lines (95% CI smaller dashed lines); and unadjusted cumulative incidence using Kaplan Meier survival models. CI indicates confidence interval; and CLI, chronic limb ischemia.
Figure 3.
Figure 3.
Cumulative incidence by indication and procedure type. Peripheral endovascular intervention, solid line (95% CI dotted lines); lower extremity bypass, long dashed lines (95% CI smaller dashed lines). CI indicates confidence interval; and CLI, chronic limb ischemia.
See this image and copyright information in PMC

References

    1. Hiatt WR. Medical treatment of peripheral arterial disease and claudication. N Engl J Med. 2001;344:1608–1621. doi: 10.1056/NEJM200105243442108. - PubMed
    1. Hirsch AT, Criqui MH, Treat-Jacobson D, Regensteiner JG, Creager MA, Olin JW, Krook SH, Hunninghake DB, Comerota AJ, Walsh ME, McDermott MM, Hiatt WR. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001;286:1317–1324. - PubMed
    1. Valadares MC, Bincoletto C, Oliveira SC, de Melo A, Saad ST, Queiroz ML. Bone marrow progenitor cells from chemically exposed workers display an intrinsic ability for autonomous proliferation. Immunopharmacol Immunotoxicol. 2005;27:137–145. doi: 10.1081/IPH-51761. - PubMed
    1. Anderson PL, Gelijns A, Moskowitz A, Arons R, Gupta L, Weinberg A, Faries PL, Nowygrod R, Kent KC. Understanding trends in inpatient surgical volume: Vascular interventions, 1980–2000. J Vasc Surg. 2004;39:1200–1208. - PubMed
    1. Kakkos SK, Geroulakos G, Nicolaides AN. Improvement of the walking ability in intermittent claudication due to superficial femoral artery occlusion with supervised exercise and pneumatic foot and calf compression: a randomised controlled trial. Eur J Vasc Endovasc Surg. 2005;30:164–175. doi: 10.1016/j.ejvs.2005.03.011. - PubMed

Publication types

MeSH terms