The Incidence and Consequences of Endovascular Technical Failure in Patients with Chronic Limb-Threatening Ischemia: Results from the Best Endovascular versus Best Surgical Therapy in Patients with Critical Limb-Threatening Ischemia (BEST-CLI) Trial.
Richard J Powell, Alik Farber, Gheorghe Doros, David Chew, Michael S Conte, Michael D Dake, Sharon Kiang, Matthew T Menard, Kenneth Rosenfield, Peter A Schneider, Jeffrey J Siracuse, Palma Shaw, Michael B Strong, Thomas Todoran, Christopher J White, John A Kaufman
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引用次数: 0
Abstract
Purpose: To analyze the causes and clinical impacts of endovascular technical failure (ETF) in the Best Endovascular versus Best Surgical Therapy in Patients with Critical Limb-Threatening Ischemia (BEST-CLI) trial, which compared endovascular therapy with bypass surgery in patients with chronic limb-threatening ischemia (CLTI).
Materials and methods: Patients with CLTI were randomized to infrainguinal bypass or endovascular therapy. ETF was defined as the inability to complete the endovascular procedure. Patients with ETF were compared with those without ETF. Causes of ETF and impact on major adverse limb event (MALE), above-ankle amputation, and death were analyzed. ETF occurred in 16% (146 of 896) of endovascular procedures.
Results: Patients who experienced ETF were older (69 years [SD ± 10] vs 67 years [SD ± 10], P = .007), were less frequently Hispanic, and had more complex infrainguinal arterial occlusive disease than those without ETF. ETF had more multilevel arterial occlusions involving a combination of both the superficial femoral artery (SFA)/popliteal segments and tibial segments (52% vs 41%, P = .029); Wound, Ischemia, and foot Infection ischemia Grade 3 (70.3% vs 53.1%, P = .002); and occlusion of the proximal SFA (37% vs 19%, P < .001). Causes of ETF included inability to cross the lesion in 82%. Following ETF, 67% underwent bypass surgery within 2 weeks of ETF. ETF was associated with a higher rate of MALE (81% vs 29%, P < .0001) but similar rates of above-ankle amputation (18.7% vs 16.0%, P = .528) and all-cause death (38.6% vs 29.8%, P = .260) at 3 years compared with no ETF.
Conclusions: ETF occurred in 16% of patients with CLTI and was associated with multilevel occlusions and proximal SFA occlusion. ETF was due to inability to cross the lesion in 82%. It did not impact long-term above-ankle amputation or death but was associated with increased major revascularization.
期刊介绍：
JVIR, published continuously since 1990, is an international, monthly peer-reviewed interventional radiology journal. As the official journal of the Society of Interventional Radiology, JVIR is the peer-reviewed journal of choice for interventional radiologists, radiologists, cardiologists, vascular surgeons, neurosurgeons, and other clinicians who seek current and reliable information on every aspect of vascular and interventional radiology. Each issue of JVIR covers critical and cutting-edge medical minimally invasive, clinical, basic research, radiological, pathological, and socioeconomic issues of importance to the field.
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