Lower Extremity Bypass and Infrainguinal Endovascular Intervention Fail to Meet SVS Performance Goals
November 29, 2018—In Journal of Vascular Surgery (JVS), William P. Robinson, MD, et al reported results from a contemporary national cohort study aiming to determine whether lower extremity bypass (LEB) and infrainguinal endovascular intervention (IEI) to treat critical limb ischemia (CLI) were meeting 30-day safety benchmarks. Results of the study were first presented at the 2017 Vascular Annual Meeting of the Society for Vascular Surgery (SVS) held May 31–June 3, 2017 in San Diego California.
According to the authors in JVS, the SVS developed objective performance goals (OPGs) in 2009, based on randomized LEB trials, to define therapeutic benchmarks for CLI therapy. These guidelines were then applied to 11,043 revascularizations for CLI performed from 2011 to 2015 in the National Surgical Quality Improvement Program (NSQIP) vascular targeted modules. The study included two NSQIP cohorts (LEB = 3,833; IEI = 3,526), as well as subgroups of patients at high anatomic risk for infrapopliteal revascularization and high clinical risk in those older than 80 years and with tissue loss.
Primary 30-day safety OPGs were defined as major adverse cardiovascular events, major adverse limb events, and amputation, and these rates were calculated for the NSQIP cohorts and subgroups.
Comparing NSQIP LEB and IEI to the SVS OPG cohorts, the investigators concluded that LEB and IEI for CLI did not meet the SVS OPG limb-related 30-day safety benchmarks for the entire CLI cohort or for patients at high anatomic risk. However, LEB and IEI did surpass OPG benchmarks for cardiovascular morbidity and mortality.