Comparison of the results of surgical and endovascular treatment in patients with peripheral arterial disease of the lower extremities in the femoropopliteal region

Česká verze

Authors: J. Pobehová ¹; Ľ. Špak ³; P. Pobeha ⁴; P. Joppa ⁴; F. Sabol ²; M. Frankovičová ¹
Authors place of work: Klinika cievnej chirurgie LF UPJŠ v Košiciach a VÚSCH, a. s., prednosta: prof. MUDr. M. Frankovičová, PhD. ¹; Klinika srdcovej chirurgie LF UPJŠ v Košiciach a VÚSCH, a. s., prednosta: MUDr. F. Sabol, PhD. ²; Angiologické oddelenie Kliniky kardiológie LF UPJŠ v Košiciach a VÚSCH, a. s., prednosta: MUDr. S. Juhás, CSc. ³; Lekárska fakulta UPJŠ v Košiciach, dekan: Dr. h. c. prof. MUDr. L. Siegfried, CSc. ⁴
Published in the journal: Rozhl. Chir., 2014, roč. 93, č. 8, s. 416-423.
Category: Původní práce

Summary

Introduction:
Results of previous studies comparing bypass surgery and percutaneous transluminal angioplasty in peripheral artery disease are ambiguous. Therefore, the aim of our study was to analyse and compare the long-term results of surgical and endovascular revascularisation in patients with peripheral artery disease in the femoropopliteal region.

Material and methods:
255 patients with peripheral artery disease who underwent bypass surgery or percutaneous transluminal angioplasty for newly diagnosed infrainguinal lesions in the femoropopliteal region were retrospectively identified and analyzed. Clinical and technical success, primary and secondary patency, improvement of critical limb ischaemia symptoms and improvement of the claudication interval were assessed within 1 year following treatment. Secondary evaluated outcomes were complications including haematoma after intervention, the need for revascularization and need for amputation of the thigh within 1 year after the intervention. Clinical outcomes were statistically evaluated as odds ratio and confidence interval.

Results:
Patients were divided into two groups: the first one was formed by 93 (36.47%) patients who underwent bypass surgery, the second one consisted of 162 (63.53%) patients who underwent endovascular therapy - percutaneous transluminal angioplasty. We could not find differences in clinical and technical success, primary and secondary patency and claudication interval improvement between the treatment groups within 1 year of follow-up after the intervention. In comparison to the endovascular group, we observed a 1.85 times higher rate of clinical improvement of critical limb ischaemia symptoms after 1year following the intervention in the bypass surgery group patients − OR 1.85 (1.10–3.10), p=0.020. Multiple logistic regression analysis showed that type of intervention was the only predictor of improvement in critical limb ischemia symptoms, independently of claudication interval before intervention, age, gender, active smoking, diabetes mellitus, hypertension and ischaemic heart disease (p=0,004). The bypass surgery group had a higher incidence of haematoma due to intervention than the endovascular group − OR 4.23 (1.27–14.15), p=0.019. No differences were detected between the treatment groups in the need for revascularisation or amputation of the thigh within 1 year following intervention.

Conclusion:
The use of bypass surgery has been associated with a higher rate of clinical improvement in critical limb ischaemia symptoms after 1 year of intervention and presence of haematoma after the intervention. No differences were detected between patients with peripheral artery disease in the femoropopliteal region treated by bypass surgery or percutaneous transluminal angioplasty in clinical and technical success, primary and secondary patency, nor in the improvement of the claudication interval during 1 year of follow-up. We also could not observe differences in the need for revascularisation or amputation of the thigh within 1 year following the intervention.

Key words:
lower limb peripheral artery disease − bypass surgery − percutaneous transluminal angioplasty − critical limb ischaemia

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