The extent of lower extremity occlusive disease predicts short- and long-term patency following endovascular infrainguinal arterial intervention

Hasanadka, Ravishankar; Brown, Kellie R.; Rilling, William S.; Rossi, Peter J.; Hieb, Robert A.; Hohenwalter, Eric J.; Seabrook, Gary R.; Lewis, Brian D.; Towne, Jonathan B.

doi:10.1016/j.amjsurg.2008.07.010

« Previous Next »The American Journal of Surgery
Volume 196, Issue 5 , Pages 629-633, November 2008

The extent of lower extremity occlusive disease predicts short- and long-term patency following endovascular infrainguinal arterial intervention

Ravishankar Hasanadka, M.D.
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
Kellie R. Brown, M.D.
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Corresponding author. Tel.: +1-414-805-9160; fax: +1-414-805-9170
William S. Rilling, M.D.
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
Peter J. Rossi, M.D.
- Hopedale Medical Complex, Hopedale, IL, USA
Robert A. Hieb, M.D.
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
Eric J. Hohenwalter, M.D.
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
Gary R. Seabrook, M.D.
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
Brian D. Lewis, M.D.
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
Jonathan B. Towne, M.D.
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA

Received 20 May 2008; received in revised form 10 July 2008 published online 15 September 2008.

Abstract

Background

Endovascular revascularization of the femoral-politeal arterial segment has gained acceptance despite lower patency than surgical bypass due to lower morbidity. Choosing patients that are ideal candidates for endovascular therapy remains controversial. We have assessed hemodynamic factors that might predict longer primary patency after endovascular therapy.

Methods

Ninety-nine limbs were treated with endovascular therapy from January 2001 to January 2005 with a mean and median follow-up of 338 and 293 days. Primary patency was considered lost when recurrent symptoms developed, ankle-brachial index (ABI) decreased following initial improvement, or a subsequent procedure was required. Kaplan-Meier analysis was used to evaluate patency.

Results

Patients with an ABI ≥.5 prior to intervention had longer primary patency compared to those with an ABI less than .5 (P = .043). Having 1 or more patent tibial runoff vessels was associated with improved patency for the first 24 months post-procedure (P = .001).

Conclusions

Patients with an ABI ≥.5 or at least 1 patent tibial vessel runoff have significantly higher hemodynamic and clinical success following endovascular therapy of the femoral-popliteal arterial segment.

Keywords: Femoral, Popliteal, Artery, Angioplasty, Stent, Ankle-brachial index