Researchers followed patients with critical limb ischemia, which is the most severe form of clogged leg arteries. It can lead to slow healing of leg wounds, gangrene and amputation.
“Critical limb ischemia is usually not an emergency, and there is time to determine the most appropriate course of therapy,” said Dr. Jonathan Lin, a surgery resident at the University of California, Davis Health.
One treatment for critical limb ischemia is open surgery, in which a section of vein from the patient (or synthetic material) is used to bypass the blockage. This enables blood to reach the lower leg and foot.
Another option is a less invasive endovascular procedure, in which a thin, flexible tube and wire are inserted through a small incision in the groin and guided to the blocked area to open it. It is then kept open by inserting a stent.
Open surgery requires hospital admission and about a month of recovery. Endovascular procedures can be done on an outpatient basis and on patients who aren’t healthy enough for open surgery.
In this study, researchers analyzed the medical records of more than 16,000 patients in California, average age 71. They had either open bypass first (36%) or an endovascular procedure first (64%) for critical limb ischemia between 2005 and 2013.
Compared to those who had open surgery, patients who had an endovascular procedure had longer amputation-free survival. They were also less likely to require a major amputation below or above the knee; slightly more likely to require another procedure or surgery to restore blood flow; and no more likely to die, even though many had serious health problems such as kidney failure, heart failure and diabetes.
The study was published July 30 in the journal Circulation: Cardiovascular Quality and Outcomes.
“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 in a journal news release.
“Regardless, the type of therapy a patient will receive needs to be a decision that patients and their physicians arrive at together,” Lin said.
Critical limb ischemia is on the rise as the U.S. population ages. It’s estimated that the number of patients who undergo amputation due to the condition will more than double from 1.6 million to 3.6 million by the year 2050.