HealthDay News — For patients with critical limb ischemia, open surgery first is associated with worse amputation-free survival but not with increased mortality compared with endovascular surgery first, according to a study published online July 30 in Circulation: Cardiovascular Quality and Outcomes.
Jonathan H. Lin, M.D., from the University of California Davis Medical Center in Sacramento, and colleagues compared amputation-free survival and reintervention rates among patients treated with initial open surgical bypass or endovascular intervention for ischemic ulcers of the lower extremities. Data were included for 16,800 patients with lower-extremity ulcers and a diagnosis of peripheral artery disease who underwent a revascularization procedure from 2005 to 2013. The initial treatment was open surgical bypass in 36 percent of patients and endovascular intervention in 64 percent.
The researchers found that open surgery first was associated with worse amputation-free survival after inverse propensity weighting as well as adjustment for patient ability to manage their disease and hospital revascularization experience (hazard ratio, 1.16; 95 percent confidence interval, 1.13 to 1.20); however, there was no difference in mortality (hazard ratio, 0.94; 95 percent confidence interval, 0.89 to 1.11). Higher rates of reintervention were seen in association with endovascular surgery first (hazard ratio, 1.19; 95 percent confidence interval, 1.14 to 1.23).
“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 statement.