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Growing impact of restenosis on the surgical treatment of peripheral arterial disease
Surgery Publications and Presentations
  • Douglas W. Jones, New York Presbyterian Hospital
  • Andres Schanzer, University of Massachusetts Medical School
  • Yuanyuan Zhao, Dartmouth-Hitchcock Medical Center
  • Todd A. MacKenzie, Dartmouth Institute for Health Policy and Clinical Practice
  • Brian W. Nolan, Dartmouth-Hitchcock Medical Center
  • Michael S. Conte, University of California at San Francisco
  • Philip P. Goodney, Dartmouth-Hitchcock Medical Center
UMMS Affiliation
Department of Surgery
Date
11-25-2013
Document Type
Article
Abstract
BACKGROUND: Patients with peripheral arterial disease often experience treatment failure from restenosis at the site of a prior peripheral endovascular intervention (PVI) or lower extremity bypass (LEB). The impact of these treatment failures on the utilization and outcomes of secondary interventions is poorly understood. METHODS AND RESULTS: In our regional vascular quality improvement collaborative, we compared 2350 patients undergoing primary infrainguinal LEB with 1154 patients undergoing secondary infrainguinal LEB (LEB performed after previous revascularization in the index limb) between 2003 and 2011. The proportion of patients undergoing secondary LEB increased by 72% during the study period (22% of all LEBs in 2003 to 38% in 2011, P<0.001). In-hospital outcomes, such as myocardial infarction, death, and amputation, were similar between primary and secondary LEB groups. However, in both crude and propensity-weighted analyses, secondary LEB was associated with significantly inferior 1-year outcomes, including major adverse limb event-free survival (composite of death, new bypass graft, surgical bypass graft revision, thrombectomy/thrombolysis, or above-ankle amputation; Secondary LEB MALE-free survival = 61.6% vs primary LEB MALE-free survival = 67.5%, P=0.002) and reintervention or amputation-free survival (composite of death, reintervention, or above-ankle amputation; Secondary LEB RAO-free survival = 58.9% vs Primary LEB RAO-free survival 64.1%, P=0.003). Inferior outcomes for secondary LEB were observed regardless of the prior failed treatment type (PVI or LEB). CONCLUSIONS: In an era of increasing utilization of PVI, a growing proportion of patients undergo LEB in the setting of a prior failed PVI or surgical bypass. When caring for patients with peripheral arterial disease, physicians should recognize that first treatment failure (PVI or LEB) affects the success of subsequent revascularizations.
Comments

Citation: Jones DW, Schanzer A, Zhao Y, MacKenzie TA, Nolan BW, Conte MS, Goodney PP; Vascular Study Group of New England. Growing impact of restenosis on the surgical treatment of peripheral arterial disease. J Am Heart Assoc. 2013 Nov 25;2(6):e000345. doi: 10.1161/JAHA.113.000345. Link to article on publisher's site

Copyright 2013 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Related Resources
Link to Article in PubMed
Keywords
  • angioplasty,
  • bypass,
  • peripheral vascular disease,
  • restenosis,
  • revascularization,
  • stents
PubMed ID
24275626
Citation Information
Douglas W. Jones, Andres Schanzer, Yuanyuan Zhao, Todd A. MacKenzie, et al.. "Growing impact of restenosis on the surgical treatment of peripheral arterial disease" Vol. 2 Iss. 6 (2013) ISSN: 2047-9980 (Linking)
Available at: http://works.bepress.com/andres_schanzer/58/