It is projected the number of those who will undergo amputation will more than double by 2050 to reach 3.6 million due to the incidence of critical limb ischemia increasing along with the aging population. Patients who underwent less invasive procedures to open clogged leg arteries were found to be just as likely to survive with their legs intact as those who had more invasive open surgery in this study.
“The question has been whether to first offer an open surgery or an endovascular procedure to patients with critical limb ischemia. Each strategy has its benefits, but it is unclear which one first is optimal and we wanted to gain a better understanding of what the current outcomes were,” said Jonathan Lin, M.D.
In hopes to avoid amputation a section on vein is used to bypass the blockage to provide a route for blood flow during open surgery, this procedure requires a hospital stay and about a month of recovery. During the less invasive endovascular procedure access is gained inside the artery with a thin tube and wire that is inserted through a small incision and guided to the blocked area, after it is opened it can be supported and propped open by inserting a medicine coated wire mesh tube; this an outpatient procedure and may be performed on those who are not healthy enough for open surgery.
Records of over 16,000 patients were examined that had undergone open bypass first, or an endovascular procedure first for critical limb ischemia. Those who were first treated with an endovascular procedure were found to have had a longer period of amputation free survival and were less likely to require a major amputation, but were slightly more likely to require another procedure to restore blood flow, and were no more likely to die.
“The data here suggest that, in the grand scheme of things, an endovascular-first approach is at least not producing a worse result,” Lin said. “Regardless, the type of therapy a patient will receive needs to be a decision that patients and their physicians arrive at together. Critical limb ischemia is usually not an emergency and there is time to determine the most appropriate course of therapy. “
The study was limited to having a population limited in specific hospitals in California, and not having information on medical factors that may have influenced whether patients were treated with open surgery or an endovascular procedure.
