Target outflow vessel compromise after failed endovascular interventions for infra-inguinal arterial disease.

INTRODUCTION

Even after two major RCTs, the BEST CLI and BASIL II, the debate about best strategy to address infra-inguinal arterial disease continues. Damage of distal outflow vessels after failed angioplasties and compromise to future options remains the main concern of bypass-first strategy advocates versus endovascular enthusiasts.

OBJECTIVES

To assess the degree of target outflow vessels damage after failed angioplasties.

METHODS

This was a retrospective study looking at all episodes of failed angioplasties for infra-inguinal arterial disease over 5 years. Primary end points were the presence and extent of damage to target outflow vessels. Secondary endpoints included complications, mortality, re-intervention types, and their success rates.

RESULTS

There were 101 failed episodes out of 724 infra-inguinal angioplasties (primary success 86 %). The mean age of failed angioplasty cases was 73 (+- 10.5) years. There was no damage to target outflow vessels after failed angioplasty in 78.2 % of the episodes. Redo angioplasty was attempted in 43 %, with 42 % success rate (p-value 0.069), while Open surgical bypass "OSB" was performed for 21 % of the cases with a success rate of 91 % (p-value 0.009)

CONCLUSION

An endovascular-first strategy for treatment of peripheral arterial disease "PAD is safe and effective. The concern for compromised future options is not justified.