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Maarit Venermo - One of the best experts on this subject based on the ideXlab platform.

  • infrainguinal percutaneous transluminal angioplasty or Bypass Surgery in patients aged 80 years and older with critical leg ischaemia
    2011
    Co-Authors: E Arvela, Maarit Venermo, Maria Soderstrom, M Korhonen, Karoliina Halmesmaki, Anders Alback, M Lepantalo, Fausto Biancari
    Abstract:

    Background: Infrainguinal revascularization for critical leg ischaemia (CLI) in patients aged 80 years and over is associated with increased operative risk. The aim was to compare the results of percutaneous transluminal angioplasty (PTA) and Bypass Surgery in these patients. Methods: Some 584 consecutive patients aged at least 80 years treated with either PTA (277) or Bypass Surgery (307) for CLI between 2000 and 2007 were included in this study. Results: After 2 years PTA achieved better results than Bypass Surgery (leg salvage: 85·4 versus 78· 7p er cent,P = 0·039; survival: 57·7 versus 52· 3p er cent,P = 0·014; amputation-free survival (AFS): 53·0 versus 44· 9p er cent,P = 0·005). Cox regression analysis showed that increased age (relative risk (RR) 1·05, 95 per cent confidence interval 1·02 to 1·08), decreased estimated glomerular filtration rate (RR 0·99, 0·99 to 1·00), diabetes (RR 1·30, 1·04 to 1·62), coronary artery disease (RR 1·36, 1·05 to 1·75) and Bypass Surgery (RR 1·55, 1·24 to 1·93) were associated with decreased AFS. In 95 propensity scorematched pairs, leg salvage at 2 years (88 versus 75 per cent; P = 0·010) and AFS (53 versus 45 per cent; P = 0·033) were significantly better after PTA. Classification and regression tree analysis suggested that PTA was associated with better 1-year AFS, especially in patients with coronary artery disease (63·8 versus 48· 9p er cent;P = 0·008). Conclusion: When feasible, a strategy of PTA first appears to achieve better results than infrainguinal Bypass Surgery in patients aged 80 years and older.

  • femoropopliteal balloon angioplasty vs Bypass Surgery for cli a propensity score analysis
    2011
    Co-Authors: M Korhonen, E Arvela, Maria Soderstrom, Karoliina Halmesmaki, Anders Alback, M Lepantalo, Fausto Biancari, Maarit Venermo
    Abstract:

    OBJECTIVES: To compare the outcomes of femoropopliteal percutaneous transluminal angioplasty (PTA) and Bypass Surgery for critical limb ischaemia (CLI). DESIGN: The study is retrospective in nature. MATERIALS AND METHODS: This study included 858 consecutive patients, who underwent femoropopliteal revascularisation for CLI at Helsinki University Central Hospital during 2000-2007. As many as 517 patients (60%) underwent PTA and 341 (40%) Bypass Surgery. Propensity score analysis was used for risk adjustment in multivariable analysis and for one-to-one matching. RESULTS: In the overall series, PTA had poorer long-term results than Bypass (5-year leg salvage, 78.2% vs. 91.8%, p < 0.0001; survival 49.2% vs. 57.1%, p = 0.048; amputation-free survival, 42.0% vs. 53.7%, p = 0.003; freedom from surgical re-intervention 86.2% vs. 94.3%, p < 0.0001). When treatment method was adjusted for propensity score as well as in the propensity score-matched pairs, leg salvage and freedom from surgical re-intervention were worse after PTA than after Bypass (among the 241 propensity score-matched pairs, 74.3% vs. 88.2%, p = 0.031, and 86.1% vs. 89.8%, p = 0.025, respectively). Differences in survival, amputation-free survival and freedom from any re-intervention were not observed. CONCLUSIONS: In CLI patients, femoropopliteal PTA seems to be associated with poorer long-term leg salvage and freedom from surgical re-intervention than Bypass Surgery. However, the treatment method did not affect long-term amputation-free survival.

  • infrapopliteal percutaneous transluminal angioplasty versus Bypass Surgery as first line strategies in critical leg ischemia a propensity score analysis
    2010
    Co-Authors: Maria Soderstrom, E Arvela, M Korhonen, Karoliina Halmesmaki, Anders Alback, M Lepantalo, Fausto Biancari, Maarit Venermo
    Abstract:

    Introduction: Recently, endovascular revascularization (percutaneous transluminal angioplasty [PTA]) has challenged Surgery as a method for the salvage of critically ischemic legs (CLI). Comparison of surgical and endovascular techniques in randomized controlled trials is difficult because of differences in patient characteristics. To overcome this problem, we adjusted the differences by using propensity score analysis. Materials and Methods: The study cohort comprised 1023 patients treated for CLI with 262 endovascular and 761 surgical revascularization procedures to their crural or pedal arteries. A propensity score was used for adjustment in multivariable analysis, for stratification, and for one-to-one matching. Results: In the overall series, PTA and Bypass Surgery achieved similar 5-year leg salvage (75.3% vs 76.0%), survival (47.5% vs 43.3%), and amputation-free survival (37.7% vs 37.3%) rates and similar freedom from any further revascularization (77.3% vs 74.4%), whereas freedom from surgical revascularization was higher after Bypass Surgery (94.3% vs 86.2%, P < 0.001). In propensity-score-matched pairs, outcomes did not differ, except for freedom from surgical revascularization, which was significantly higher in the Bypass Surgery group (91.4% vs 85.3% at 5 years, P = 0.045). In a subgroup of patients who underwent isolated infrapopliteal revascularization, PTA was associated with better leg salvage (75.5% vs 68.0%, P = 0.042) and somewhat lower freedom from surgical revascularization (78.8% vs 85.2%, P = 0.17). This significant difference in the leg salvage rate was also observed after adjustment for propensity score (P = 0.044), but not in propensity-score-matched pairs (P = 0.12). Conclusions: When feasible, infrapopliteal PTA as a first-line strategy is expected to achieve similar long-term results to Bypass Surgery in CLI when redo Surgery is actively utilized.

Fausto Biancari - One of the best experts on this subject based on the ideXlab platform.

  • infrainguinal percutaneous transluminal angioplasty or Bypass Surgery in patients aged 80 years and older with critical leg ischaemia
    2011
    Co-Authors: E Arvela, Maarit Venermo, Maria Soderstrom, M Korhonen, Karoliina Halmesmaki, Anders Alback, M Lepantalo, Fausto Biancari
    Abstract:

    Background: Infrainguinal revascularization for critical leg ischaemia (CLI) in patients aged 80 years and over is associated with increased operative risk. The aim was to compare the results of percutaneous transluminal angioplasty (PTA) and Bypass Surgery in these patients. Methods: Some 584 consecutive patients aged at least 80 years treated with either PTA (277) or Bypass Surgery (307) for CLI between 2000 and 2007 were included in this study. Results: After 2 years PTA achieved better results than Bypass Surgery (leg salvage: 85·4 versus 78· 7p er cent,P = 0·039; survival: 57·7 versus 52· 3p er cent,P = 0·014; amputation-free survival (AFS): 53·0 versus 44· 9p er cent,P = 0·005). Cox regression analysis showed that increased age (relative risk (RR) 1·05, 95 per cent confidence interval 1·02 to 1·08), decreased estimated glomerular filtration rate (RR 0·99, 0·99 to 1·00), diabetes (RR 1·30, 1·04 to 1·62), coronary artery disease (RR 1·36, 1·05 to 1·75) and Bypass Surgery (RR 1·55, 1·24 to 1·93) were associated with decreased AFS. In 95 propensity scorematched pairs, leg salvage at 2 years (88 versus 75 per cent; P = 0·010) and AFS (53 versus 45 per cent; P = 0·033) were significantly better after PTA. Classification and regression tree analysis suggested that PTA was associated with better 1-year AFS, especially in patients with coronary artery disease (63·8 versus 48· 9p er cent;P = 0·008). Conclusion: When feasible, a strategy of PTA first appears to achieve better results than infrainguinal Bypass Surgery in patients aged 80 years and older.

  • femoropopliteal balloon angioplasty vs Bypass Surgery for cli a propensity score analysis
    2011
    Co-Authors: M Korhonen, E Arvela, Maria Soderstrom, Karoliina Halmesmaki, Anders Alback, M Lepantalo, Fausto Biancari, Maarit Venermo
    Abstract:

    OBJECTIVES: To compare the outcomes of femoropopliteal percutaneous transluminal angioplasty (PTA) and Bypass Surgery for critical limb ischaemia (CLI). DESIGN: The study is retrospective in nature. MATERIALS AND METHODS: This study included 858 consecutive patients, who underwent femoropopliteal revascularisation for CLI at Helsinki University Central Hospital during 2000-2007. As many as 517 patients (60%) underwent PTA and 341 (40%) Bypass Surgery. Propensity score analysis was used for risk adjustment in multivariable analysis and for one-to-one matching. RESULTS: In the overall series, PTA had poorer long-term results than Bypass (5-year leg salvage, 78.2% vs. 91.8%, p < 0.0001; survival 49.2% vs. 57.1%, p = 0.048; amputation-free survival, 42.0% vs. 53.7%, p = 0.003; freedom from surgical re-intervention 86.2% vs. 94.3%, p < 0.0001). When treatment method was adjusted for propensity score as well as in the propensity score-matched pairs, leg salvage and freedom from surgical re-intervention were worse after PTA than after Bypass (among the 241 propensity score-matched pairs, 74.3% vs. 88.2%, p = 0.031, and 86.1% vs. 89.8%, p = 0.025, respectively). Differences in survival, amputation-free survival and freedom from any re-intervention were not observed. CONCLUSIONS: In CLI patients, femoropopliteal PTA seems to be associated with poorer long-term leg salvage and freedom from surgical re-intervention than Bypass Surgery. However, the treatment method did not affect long-term amputation-free survival.

  • infrapopliteal percutaneous transluminal angioplasty versus Bypass Surgery as first line strategies in critical leg ischemia a propensity score analysis
    2010
    Co-Authors: Maria Soderstrom, E Arvela, M Korhonen, Karoliina Halmesmaki, Anders Alback, M Lepantalo, Fausto Biancari, Maarit Venermo
    Abstract:

    Introduction: Recently, endovascular revascularization (percutaneous transluminal angioplasty [PTA]) has challenged Surgery as a method for the salvage of critically ischemic legs (CLI). Comparison of surgical and endovascular techniques in randomized controlled trials is difficult because of differences in patient characteristics. To overcome this problem, we adjusted the differences by using propensity score analysis. Materials and Methods: The study cohort comprised 1023 patients treated for CLI with 262 endovascular and 761 surgical revascularization procedures to their crural or pedal arteries. A propensity score was used for adjustment in multivariable analysis, for stratification, and for one-to-one matching. Results: In the overall series, PTA and Bypass Surgery achieved similar 5-year leg salvage (75.3% vs 76.0%), survival (47.5% vs 43.3%), and amputation-free survival (37.7% vs 37.3%) rates and similar freedom from any further revascularization (77.3% vs 74.4%), whereas freedom from surgical revascularization was higher after Bypass Surgery (94.3% vs 86.2%, P < 0.001). In propensity-score-matched pairs, outcomes did not differ, except for freedom from surgical revascularization, which was significantly higher in the Bypass Surgery group (91.4% vs 85.3% at 5 years, P = 0.045). In a subgroup of patients who underwent isolated infrapopliteal revascularization, PTA was associated with better leg salvage (75.5% vs 68.0%, P = 0.042) and somewhat lower freedom from surgical revascularization (78.8% vs 85.2%, P = 0.17). This significant difference in the leg salvage rate was also observed after adjustment for propensity score (P = 0.044), but not in propensity-score-matched pairs (P = 0.12). Conclusions: When feasible, infrapopliteal PTA as a first-line strategy is expected to achieve similar long-term results to Bypass Surgery in CLI when redo Surgery is actively utilized.

Maria Soderstrom - One of the best experts on this subject based on the ideXlab platform.

  • infrainguinal percutaneous transluminal angioplasty or Bypass Surgery in patients aged 80 years and older with critical leg ischaemia
    2011
    Co-Authors: E Arvela, Maarit Venermo, Maria Soderstrom, M Korhonen, Karoliina Halmesmaki, Anders Alback, M Lepantalo, Fausto Biancari
    Abstract:

    Background: Infrainguinal revascularization for critical leg ischaemia (CLI) in patients aged 80 years and over is associated with increased operative risk. The aim was to compare the results of percutaneous transluminal angioplasty (PTA) and Bypass Surgery in these patients. Methods: Some 584 consecutive patients aged at least 80 years treated with either PTA (277) or Bypass Surgery (307) for CLI between 2000 and 2007 were included in this study. Results: After 2 years PTA achieved better results than Bypass Surgery (leg salvage: 85·4 versus 78· 7p er cent,P = 0·039; survival: 57·7 versus 52· 3p er cent,P = 0·014; amputation-free survival (AFS): 53·0 versus 44· 9p er cent,P = 0·005). Cox regression analysis showed that increased age (relative risk (RR) 1·05, 95 per cent confidence interval 1·02 to 1·08), decreased estimated glomerular filtration rate (RR 0·99, 0·99 to 1·00), diabetes (RR 1·30, 1·04 to 1·62), coronary artery disease (RR 1·36, 1·05 to 1·75) and Bypass Surgery (RR 1·55, 1·24 to 1·93) were associated with decreased AFS. In 95 propensity scorematched pairs, leg salvage at 2 years (88 versus 75 per cent; P = 0·010) and AFS (53 versus 45 per cent; P = 0·033) were significantly better after PTA. Classification and regression tree analysis suggested that PTA was associated with better 1-year AFS, especially in patients with coronary artery disease (63·8 versus 48· 9p er cent;P = 0·008). Conclusion: When feasible, a strategy of PTA first appears to achieve better results than infrainguinal Bypass Surgery in patients aged 80 years and older.

  • femoropopliteal balloon angioplasty vs Bypass Surgery for cli a propensity score analysis
    2011
    Co-Authors: M Korhonen, E Arvela, Maria Soderstrom, Karoliina Halmesmaki, Anders Alback, M Lepantalo, Fausto Biancari, Maarit Venermo
    Abstract:

    OBJECTIVES: To compare the outcomes of femoropopliteal percutaneous transluminal angioplasty (PTA) and Bypass Surgery for critical limb ischaemia (CLI). DESIGN: The study is retrospective in nature. MATERIALS AND METHODS: This study included 858 consecutive patients, who underwent femoropopliteal revascularisation for CLI at Helsinki University Central Hospital during 2000-2007. As many as 517 patients (60%) underwent PTA and 341 (40%) Bypass Surgery. Propensity score analysis was used for risk adjustment in multivariable analysis and for one-to-one matching. RESULTS: In the overall series, PTA had poorer long-term results than Bypass (5-year leg salvage, 78.2% vs. 91.8%, p < 0.0001; survival 49.2% vs. 57.1%, p = 0.048; amputation-free survival, 42.0% vs. 53.7%, p = 0.003; freedom from surgical re-intervention 86.2% vs. 94.3%, p < 0.0001). When treatment method was adjusted for propensity score as well as in the propensity score-matched pairs, leg salvage and freedom from surgical re-intervention were worse after PTA than after Bypass (among the 241 propensity score-matched pairs, 74.3% vs. 88.2%, p = 0.031, and 86.1% vs. 89.8%, p = 0.025, respectively). Differences in survival, amputation-free survival and freedom from any re-intervention were not observed. CONCLUSIONS: In CLI patients, femoropopliteal PTA seems to be associated with poorer long-term leg salvage and freedom from surgical re-intervention than Bypass Surgery. However, the treatment method did not affect long-term amputation-free survival.

  • infrapopliteal percutaneous transluminal angioplasty versus Bypass Surgery as first line strategies in critical leg ischemia a propensity score analysis
    2010
    Co-Authors: Maria Soderstrom, E Arvela, M Korhonen, Karoliina Halmesmaki, Anders Alback, M Lepantalo, Fausto Biancari, Maarit Venermo
    Abstract:

    Introduction: Recently, endovascular revascularization (percutaneous transluminal angioplasty [PTA]) has challenged Surgery as a method for the salvage of critically ischemic legs (CLI). Comparison of surgical and endovascular techniques in randomized controlled trials is difficult because of differences in patient characteristics. To overcome this problem, we adjusted the differences by using propensity score analysis. Materials and Methods: The study cohort comprised 1023 patients treated for CLI with 262 endovascular and 761 surgical revascularization procedures to their crural or pedal arteries. A propensity score was used for adjustment in multivariable analysis, for stratification, and for one-to-one matching. Results: In the overall series, PTA and Bypass Surgery achieved similar 5-year leg salvage (75.3% vs 76.0%), survival (47.5% vs 43.3%), and amputation-free survival (37.7% vs 37.3%) rates and similar freedom from any further revascularization (77.3% vs 74.4%), whereas freedom from surgical revascularization was higher after Bypass Surgery (94.3% vs 86.2%, P < 0.001). In propensity-score-matched pairs, outcomes did not differ, except for freedom from surgical revascularization, which was significantly higher in the Bypass Surgery group (91.4% vs 85.3% at 5 years, P = 0.045). In a subgroup of patients who underwent isolated infrapopliteal revascularization, PTA was associated with better leg salvage (75.5% vs 68.0%, P = 0.042) and somewhat lower freedom from surgical revascularization (78.8% vs 85.2%, P = 0.17). This significant difference in the leg salvage rate was also observed after adjustment for propensity score (P = 0.044), but not in propensity-score-matched pairs (P = 0.12). Conclusions: When feasible, infrapopliteal PTA as a first-line strategy is expected to achieve similar long-term results to Bypass Surgery in CLI when redo Surgery is actively utilized.

M Korhonen - One of the best experts on this subject based on the ideXlab platform.

  • infrainguinal percutaneous transluminal angioplasty or Bypass Surgery in patients aged 80 years and older with critical leg ischaemia
    2011
    Co-Authors: E Arvela, Maarit Venermo, Maria Soderstrom, M Korhonen, Karoliina Halmesmaki, Anders Alback, M Lepantalo, Fausto Biancari
    Abstract:

    Background: Infrainguinal revascularization for critical leg ischaemia (CLI) in patients aged 80 years and over is associated with increased operative risk. The aim was to compare the results of percutaneous transluminal angioplasty (PTA) and Bypass Surgery in these patients. Methods: Some 584 consecutive patients aged at least 80 years treated with either PTA (277) or Bypass Surgery (307) for CLI between 2000 and 2007 were included in this study. Results: After 2 years PTA achieved better results than Bypass Surgery (leg salvage: 85·4 versus 78· 7p er cent,P = 0·039; survival: 57·7 versus 52· 3p er cent,P = 0·014; amputation-free survival (AFS): 53·0 versus 44· 9p er cent,P = 0·005). Cox regression analysis showed that increased age (relative risk (RR) 1·05, 95 per cent confidence interval 1·02 to 1·08), decreased estimated glomerular filtration rate (RR 0·99, 0·99 to 1·00), diabetes (RR 1·30, 1·04 to 1·62), coronary artery disease (RR 1·36, 1·05 to 1·75) and Bypass Surgery (RR 1·55, 1·24 to 1·93) were associated with decreased AFS. In 95 propensity scorematched pairs, leg salvage at 2 years (88 versus 75 per cent; P = 0·010) and AFS (53 versus 45 per cent; P = 0·033) were significantly better after PTA. Classification and regression tree analysis suggested that PTA was associated with better 1-year AFS, especially in patients with coronary artery disease (63·8 versus 48· 9p er cent;P = 0·008). Conclusion: When feasible, a strategy of PTA first appears to achieve better results than infrainguinal Bypass Surgery in patients aged 80 years and older.

  • femoropopliteal balloon angioplasty vs Bypass Surgery for cli a propensity score analysis
    2011
    Co-Authors: M Korhonen, E Arvela, Maria Soderstrom, Karoliina Halmesmaki, Anders Alback, M Lepantalo, Fausto Biancari, Maarit Venermo
    Abstract:

    OBJECTIVES: To compare the outcomes of femoropopliteal percutaneous transluminal angioplasty (PTA) and Bypass Surgery for critical limb ischaemia (CLI). DESIGN: The study is retrospective in nature. MATERIALS AND METHODS: This study included 858 consecutive patients, who underwent femoropopliteal revascularisation for CLI at Helsinki University Central Hospital during 2000-2007. As many as 517 patients (60%) underwent PTA and 341 (40%) Bypass Surgery. Propensity score analysis was used for risk adjustment in multivariable analysis and for one-to-one matching. RESULTS: In the overall series, PTA had poorer long-term results than Bypass (5-year leg salvage, 78.2% vs. 91.8%, p < 0.0001; survival 49.2% vs. 57.1%, p = 0.048; amputation-free survival, 42.0% vs. 53.7%, p = 0.003; freedom from surgical re-intervention 86.2% vs. 94.3%, p < 0.0001). When treatment method was adjusted for propensity score as well as in the propensity score-matched pairs, leg salvage and freedom from surgical re-intervention were worse after PTA than after Bypass (among the 241 propensity score-matched pairs, 74.3% vs. 88.2%, p = 0.031, and 86.1% vs. 89.8%, p = 0.025, respectively). Differences in survival, amputation-free survival and freedom from any re-intervention were not observed. CONCLUSIONS: In CLI patients, femoropopliteal PTA seems to be associated with poorer long-term leg salvage and freedom from surgical re-intervention than Bypass Surgery. However, the treatment method did not affect long-term amputation-free survival.

  • infrapopliteal percutaneous transluminal angioplasty versus Bypass Surgery as first line strategies in critical leg ischemia a propensity score analysis
    2010
    Co-Authors: Maria Soderstrom, E Arvela, M Korhonen, Karoliina Halmesmaki, Anders Alback, M Lepantalo, Fausto Biancari, Maarit Venermo
    Abstract:

    Introduction: Recently, endovascular revascularization (percutaneous transluminal angioplasty [PTA]) has challenged Surgery as a method for the salvage of critically ischemic legs (CLI). Comparison of surgical and endovascular techniques in randomized controlled trials is difficult because of differences in patient characteristics. To overcome this problem, we adjusted the differences by using propensity score analysis. Materials and Methods: The study cohort comprised 1023 patients treated for CLI with 262 endovascular and 761 surgical revascularization procedures to their crural or pedal arteries. A propensity score was used for adjustment in multivariable analysis, for stratification, and for one-to-one matching. Results: In the overall series, PTA and Bypass Surgery achieved similar 5-year leg salvage (75.3% vs 76.0%), survival (47.5% vs 43.3%), and amputation-free survival (37.7% vs 37.3%) rates and similar freedom from any further revascularization (77.3% vs 74.4%), whereas freedom from surgical revascularization was higher after Bypass Surgery (94.3% vs 86.2%, P < 0.001). In propensity-score-matched pairs, outcomes did not differ, except for freedom from surgical revascularization, which was significantly higher in the Bypass Surgery group (91.4% vs 85.3% at 5 years, P = 0.045). In a subgroup of patients who underwent isolated infrapopliteal revascularization, PTA was associated with better leg salvage (75.5% vs 68.0%, P = 0.042) and somewhat lower freedom from surgical revascularization (78.8% vs 85.2%, P = 0.17). This significant difference in the leg salvage rate was also observed after adjustment for propensity score (P = 0.044), but not in propensity-score-matched pairs (P = 0.12). Conclusions: When feasible, infrapopliteal PTA as a first-line strategy is expected to achieve similar long-term results to Bypass Surgery in CLI when redo Surgery is actively utilized.

E Arvela - One of the best experts on this subject based on the ideXlab platform.

  • infrainguinal percutaneous transluminal angioplasty or Bypass Surgery in patients aged 80 years and older with critical leg ischaemia
    2011
    Co-Authors: E Arvela, Maarit Venermo, Maria Soderstrom, M Korhonen, Karoliina Halmesmaki, Anders Alback, M Lepantalo, Fausto Biancari
    Abstract:

    Background: Infrainguinal revascularization for critical leg ischaemia (CLI) in patients aged 80 years and over is associated with increased operative risk. The aim was to compare the results of percutaneous transluminal angioplasty (PTA) and Bypass Surgery in these patients. Methods: Some 584 consecutive patients aged at least 80 years treated with either PTA (277) or Bypass Surgery (307) for CLI between 2000 and 2007 were included in this study. Results: After 2 years PTA achieved better results than Bypass Surgery (leg salvage: 85·4 versus 78· 7p er cent,P = 0·039; survival: 57·7 versus 52· 3p er cent,P = 0·014; amputation-free survival (AFS): 53·0 versus 44· 9p er cent,P = 0·005). Cox regression analysis showed that increased age (relative risk (RR) 1·05, 95 per cent confidence interval 1·02 to 1·08), decreased estimated glomerular filtration rate (RR 0·99, 0·99 to 1·00), diabetes (RR 1·30, 1·04 to 1·62), coronary artery disease (RR 1·36, 1·05 to 1·75) and Bypass Surgery (RR 1·55, 1·24 to 1·93) were associated with decreased AFS. In 95 propensity scorematched pairs, leg salvage at 2 years (88 versus 75 per cent; P = 0·010) and AFS (53 versus 45 per cent; P = 0·033) were significantly better after PTA. Classification and regression tree analysis suggested that PTA was associated with better 1-year AFS, especially in patients with coronary artery disease (63·8 versus 48· 9p er cent;P = 0·008). Conclusion: When feasible, a strategy of PTA first appears to achieve better results than infrainguinal Bypass Surgery in patients aged 80 years and older.

  • femoropopliteal balloon angioplasty vs Bypass Surgery for cli a propensity score analysis
    2011
    Co-Authors: M Korhonen, E Arvela, Maria Soderstrom, Karoliina Halmesmaki, Anders Alback, M Lepantalo, Fausto Biancari, Maarit Venermo
    Abstract:

    OBJECTIVES: To compare the outcomes of femoropopliteal percutaneous transluminal angioplasty (PTA) and Bypass Surgery for critical limb ischaemia (CLI). DESIGN: The study is retrospective in nature. MATERIALS AND METHODS: This study included 858 consecutive patients, who underwent femoropopliteal revascularisation for CLI at Helsinki University Central Hospital during 2000-2007. As many as 517 patients (60%) underwent PTA and 341 (40%) Bypass Surgery. Propensity score analysis was used for risk adjustment in multivariable analysis and for one-to-one matching. RESULTS: In the overall series, PTA had poorer long-term results than Bypass (5-year leg salvage, 78.2% vs. 91.8%, p < 0.0001; survival 49.2% vs. 57.1%, p = 0.048; amputation-free survival, 42.0% vs. 53.7%, p = 0.003; freedom from surgical re-intervention 86.2% vs. 94.3%, p < 0.0001). When treatment method was adjusted for propensity score as well as in the propensity score-matched pairs, leg salvage and freedom from surgical re-intervention were worse after PTA than after Bypass (among the 241 propensity score-matched pairs, 74.3% vs. 88.2%, p = 0.031, and 86.1% vs. 89.8%, p = 0.025, respectively). Differences in survival, amputation-free survival and freedom from any re-intervention were not observed. CONCLUSIONS: In CLI patients, femoropopliteal PTA seems to be associated with poorer long-term leg salvage and freedom from surgical re-intervention than Bypass Surgery. However, the treatment method did not affect long-term amputation-free survival.

  • infrapopliteal percutaneous transluminal angioplasty versus Bypass Surgery as first line strategies in critical leg ischemia a propensity score analysis
    2010
    Co-Authors: Maria Soderstrom, E Arvela, M Korhonen, Karoliina Halmesmaki, Anders Alback, M Lepantalo, Fausto Biancari, Maarit Venermo
    Abstract:

    Introduction: Recently, endovascular revascularization (percutaneous transluminal angioplasty [PTA]) has challenged Surgery as a method for the salvage of critically ischemic legs (CLI). Comparison of surgical and endovascular techniques in randomized controlled trials is difficult because of differences in patient characteristics. To overcome this problem, we adjusted the differences by using propensity score analysis. Materials and Methods: The study cohort comprised 1023 patients treated for CLI with 262 endovascular and 761 surgical revascularization procedures to their crural or pedal arteries. A propensity score was used for adjustment in multivariable analysis, for stratification, and for one-to-one matching. Results: In the overall series, PTA and Bypass Surgery achieved similar 5-year leg salvage (75.3% vs 76.0%), survival (47.5% vs 43.3%), and amputation-free survival (37.7% vs 37.3%) rates and similar freedom from any further revascularization (77.3% vs 74.4%), whereas freedom from surgical revascularization was higher after Bypass Surgery (94.3% vs 86.2%, P < 0.001). In propensity-score-matched pairs, outcomes did not differ, except for freedom from surgical revascularization, which was significantly higher in the Bypass Surgery group (91.4% vs 85.3% at 5 years, P = 0.045). In a subgroup of patients who underwent isolated infrapopliteal revascularization, PTA was associated with better leg salvage (75.5% vs 68.0%, P = 0.042) and somewhat lower freedom from surgical revascularization (78.8% vs 85.2%, P = 0.17). This significant difference in the leg salvage rate was also observed after adjustment for propensity score (P = 0.044), but not in propensity-score-matched pairs (P = 0.12). Conclusions: When feasible, infrapopliteal PTA as a first-line strategy is expected to achieve similar long-term results to Bypass Surgery in CLI when redo Surgery is actively utilized.

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