Author + information
- S1936879815021585-d314e0f95090826cbe7b3ba087a6e6bcSarah S. Elsayed,
- S1936879815021585-3d9523d52713574934130c3bae625a27Alexander K. Mylavarapu,
- S1936879815021585-c0451d3583492b007ba6db00fcfb0e61Lucy M. Zhang,
- S1936879815021585-0be8d911c24e74203e71c74b064e0bc1Nicole E. Basler,
- S1936879815021585-87914c608311b7837cd37f2aaef18f5dJonathan Lee,
- S1936879815021585-a8a7e41fd4e45d543e3bc5070493019cDavid Cohen,
- S1936879815021585-d41de836760814c1f27254bfb490b657Parveen Garg,
- S1936879815021585-c82c99e652590142886fa0696ab1c7a2Karen Woo,
- S1936879815021585-c0fec271ec2c34308ea996ed8e6f49f0Leonardo C. Clavijo and
- S1936879815021585-b494a4f8d3658363e65b675c9fff917fDavid M. Shavelle
Endovascular treatment is being increasingly performed for patients with critical limb ischemia (CLI). We sought to determine the predictors of endovascular (Endo) versus surgical (Bypass) revascularization in patients with CLI.
This is a retrospective analysis of 174 CLI patients who were evaluated by a multidisciplinary team from 2011 to 2015 at a large, urban academic medical center and underwent lower extremity revascularization. One hundred thirteen patients (65%) underwent Endo and 61 patients (35%) underwent Bypass. Data collected included demographics, risk factors, Rutherford class and procedural and surgical details.
Mean ± SD age of the Endo and Bypass Groups was 65±11 and 59±11 years, respectively, (p=0.004). Diabetes mellitus (DM) was more prevalent in the Endo compared to the Bypass group, 78% vs 54%, p=0.001. Smoking was more prevalent in the Bypass compared to the Endo group, 39% vs 20%, p=0.007. Prior bypass was more common in the Bypass group. Below the knee (BTK) disease was more common in the Endo compared to the Bypass group, 47% vs 10%, p<0.0001.
Univariate predictors to undergo Endo included age >65 years (OR 2.5, 95% CI: 1.2-5.2, p=0.01), DM (OR 2.9, 95% CI: 1.5-5.7, p=0.002), advanced Rutherford classes 5/6 (OR 2.5, 95% CI: 1.2-4.8, p=0.007) and BTK disease (OR 8.2, 95% CI: 3.2-20.6, p<0.0001). On multivariate analysis, age >65 years (OR 2, 95% CI: 1-4.3, p=0.05) and BTK disease (OR 2.8, 95% CI: 1.2-6.3, p=0.02) were significant predictors of Endo; prior surgical bypass was less associated with Endo (OR 0.3, 95% CI: 0.1-0.8, p=0.02).
In this contemporary series of CLI patients undergoing revascularization, older age, diabetes mellitus, advanced Rutherford Class and below the knee disease were more prevalent in patients receiving endovascular therapy. Independent predictors of endovascular revascularization were age >65 years and below the knee disease.