Long-term results in the treatment of lower limb occlusive disease and abdominal aortic aneurysm.

Abstract

Background: Cardiovascular disease is the most common cause of death globally, accounting for 31 % of deaths in 2016 according to WHO statistics. Arterial disease in the lower limb, and abdominal aortic aneurysm (AAA) are common manifestations of vascular disease, which cause significant morbidity and mortality. Treatment guidelines for both conditions are based on many studies, but there are still evidence gaps, like the impact of the revascularization method for femoropopliteal ischemia on long-term results, or the consequences of the choice of treatment method for AAA for the whole patient population. Aims: - To study long term outcomes for bypass and percutaneous transluminal angioplasty (PTA) of the femoropopliteal segment for critical limb ischemia. - To study long term outcomes after hybrid revascularization of the lower limb with groin thrombendarterectomy (TEA) combined with PTA. - To study long term outcomes after treatment for AAA when endovascular repair (EVAR) is restricted to anatomy compliant with instructions for use (IFU). Methods: All studies were non-randomized, registry based retrospective cohort studies, but with complete consecutive inclusion, and truly population based. Long-term outcome data were retrieved from electronic patient records. Kaplan Meier survival analysis and other statistics were performed with SPSS® 23. Main results: Femoropopliteal bypass and PTA had similar limb salvage and survival. Patients not eligible for bypass surgery (PTA ONLY) had significantly lower limb salvage and survival. The 5-year limb salvage was 77 % for bypass, 83 % for PTA and 34 % for PTA ONLY. Hybrid operations had durable results with few reoperations and a 5-year limb salvage of 75 % in critical ischemia. Restricting EVAR to patients suitable within instructions for use gave good EVAR results and did not impair general outcome of the treatment for AAA. Conclusion: PTA is a valid first choice in critical ischemia due to lesions in the femoropopliteal segment, when technical success is likely. Hybrid operations with groin TEA and PTA have good long-term results and little need for vascular reoperations. Restricting EVAR to patients suitable within instructions for use is safe and does not impair the general outcome of the treatment for AAA.