Back to Search
Start Over
Outcomes of endovascular treatment versus bypass surgery for critical limb ischemia in patients with thromboangiitis obliterans.
- Source :
-
PloS one [PLoS One] 2018 Oct 09; Vol. 13 (10), pp. e0205305. Date of Electronic Publication: 2018 Oct 09 (Print Publication: 2018). - Publication Year :
- 2018
-
Abstract
- We aimed to compare the clinical outcomes between endovascular treatment and inframalleolar bypass surgery for critical limb ischemia (CLI) in patients with thromboangiitis obliterans (TAO) and to assess the role of bypass surgery in the era of innovative endovascular treatment. Between January 2007 and December 2017, a total of 33 consecutive patients with the diagnosis of TAO presenting with CLI who underwent endovascular treatment (endovascular group, n = 22) or bypass surgery to the pedal or plantar vessels (bypass group, n = 11) were included and analyzed retrospectively. The primary endpoint was defined as a major amputation of the index limb, and the secondary endpoint was defined as graft occlusion, regardless of the number of subsequent procedures. In the bypass group, six patients (55%) had undergone previous failed endovascular procedures and/or arterial bypass surgery to the index limb before inframalleolar bypass, and two patients (18%) received microvascular flap reconstruction after bypass surgery. During the median follow-up period of 32 months (range 1-115 months), there were no significant differences in primary and secondary endpoints between the two groups although the bypass group had a higher Rutherford class than the endovascular group. Kaplan-Meier survival analysis showed that there were similar limb salvage (P = 0.95) and graft patency rates (P = 0.39). In conclusion, endovascular treatment is a valid strategy leading to an acceptable limb salvage rate for TAO patients, and surgical bypass to distal target vessels could play a vital role in cases of previous failed endovascular treatment or extensive soft tissue loss of the foot.<br />Competing Interests: The authors have declared that no competing interests exist.
- Subjects :
- Adult
Aged
Amputation, Surgical mortality
Amputation, Surgical statistics & numerical data
Endovascular Procedures mortality
Female
Graft Occlusion, Vascular mortality
Graft Occlusion, Vascular pathology
Humans
Ischemia mortality
Ischemia pathology
Limb Salvage mortality
Limb Salvage statistics & numerical data
Lower Extremity blood supply
Lower Extremity pathology
Lower Extremity surgery
Male
Middle Aged
Retrospective Studies
Saphenous Vein pathology
Survival Analysis
Thromboangiitis Obliterans mortality
Thromboangiitis Obliterans pathology
Vascular Grafting mortality
Endovascular Procedures methods
Ischemia surgery
Saphenous Vein surgery
Thromboangiitis Obliterans surgery
Vascular Grafting methods
Subjects
Details
- Language :
- English
- ISSN :
- 1932-6203
- Volume :
- 13
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- PloS one
- Publication Type :
- Academic Journal
- Accession number :
- 30300407
- Full Text :
- https://doi.org/10.1371/journal.pone.0205305