Endovascular surgery for chronic limb ischaemia. Factors predicting immediate outcome on the basis of a nationwide vascular registry.

PURPOSE

To evaluate the early results of endovascular treatment of chronic limb ischemia and the factors influencing outcome.

METHODS

The 5,575 endovascular procedures entered into the national vascular registry in 1991-1994 were reviewed retrospectively. Indication was claudication in 3,873 and chronic critical ischemia (CLI) in 1,702 procedures. In CLI most patients were women and older, with a higher proportion of diabetes mellitus, renal insufficiency and coronary heart disease than in claudication group although the incidence of smoking and hyperlipidaemia was lower. 60.2% of the procedures were performed in femoropopliteal arteries, 24.9% in iliac arteries and 14.9% in infrapopliteal arteries. The follow-up was 30 days.

RESULTS

In the claudication group there was clinical improvement in 2,719 (82.8%) and in the CLI group in 851 (70.9%) of patients. Patency was better in the claudication than in CLI group, 94.6% vs. 89.0% respectively. There was hemodynamic improvement, i.e. improvement of the ankle-brachial index of more than 0.15 in 1,680 (58.2%) patients with claudication and in 437 (59.7%) with CLI. In a logistic regression model diabetes mellitus and renal insufficiency increased the relative risk of amputations and mortality in CLI group, whereas, incidence of amputations was lower in patients with hyperlipidaemia. In claudication group femoropopliteal arteries had an adverse effect on patency.

CONCLUSION

The clinical characteristics of the groups may explain some of the outcome differences. Angioplasty is recommended to be used in the femoropopliteal arteries if the symptoms are severe and in CLI group with diabetes and renal failure only in selected cases.