Clinical presentation and outcome after failed infrainguinal endovascular and open revascularization in patients with chronic limb ischemia

Abstract

Objective: Failure of prior endovascular (EV) interventions for chronic limb ischemia has been reported to negatively affect patency and limb salvage after subsequent revascularization procedures. The goal of our study was to compare the clinical presentation of patients who failed infrainguinal EV and open revascularizations (OR) and the effect of the initial intervention on final outcomes. Methods: From June 2001 to October 2010, 216 patients (237 limbs; 66 disabling claudication [DC], 171 critical limb ischemia [CLI]) presented with failed infrainguinal OR or EV revascularization for chronic limb ischemia. Clinical presentation, reinterventions, patency and limb salvage rates, and final outcomes were analyzed. Results: The EV group (n = 143) had more diabetes (44% vs 57%; P =.048) and ulcers (26% vs 38%; P =.039), whereas the OR group (n = 94) had more multilevel revascularizations (59% vs 33%; P <3 months) occurred in 15% of DC and in 36% of CLI patients and was more in the OR than in the EV group (30% vs 7% for DC [P =.011] and 71% vs 38% for CLI [P =.024]). Overall, 195 (82%) had attempted reinterventions (79% in DC and 85% in CLI; P =.245). In DC patients, 48% of OR had OR + EV and 26% had EV; 32% of EV had OR + EV and 47% had EV reinterventions. In CLI patients, 40% of OR had OR + EV and 42% had EV; 17% of EV had OR + EV; and 70% had EV reinterventions. A patent revascularized limb was achieved in 66% of OR and in 92% of EV patients (P