Single-Center Study Supports an Endovascular-First Approach for CLI Treatment

July 21, 2015—A shift to an endovascular-first treatment strategy for critical limb ischemia (CLI) was found to be associated with fewer major amputations and shorter length of stay in a single-center study published by Nedal Katib, MBBCh, et al in the Journal of Endovascular Therapy (JEVT; 2015;22:473–481). A change in staff at the investigators’ center—Prince of Wales Hospital in Sydney, Australia—in 2008 altered the team’s revascularization strategy for patients presenting with CLI and the effect of that shift is documented.

As summarized in JEVT, the investigators treated 344 critically ischemic limbs in 279 patients (mean age, 74 ± 11.4 years; 179 men) during 546 separate hospital admissions between 2004 and 2012.

Limbs were initially analyzed according to the principal revascularization strategy used and then according to the date of presentation (early, 2004–2008 or late, 2008–2012). In the initial analysis, the investigators reported that the endovascular revascularization (ER) group had increased freedom from major amputation compared with the open revascularization (OR) and no revascularization (NR) groups (92.3% vs 80% vs 69.3%, respectively), as well as reduced hospital stay (15.2 vs 31.6 vs 25.9 days) and intensive care unit (ICU) stay (2.3 vs 23.7 vs 7.2 hours). The procedure time for ER was 157.9 minutes compared to 316.8 minutes for OR. In the ER group, there was also a significant decrease in limbs requiring minor amputations (23.2% vs 29.3% vs 37.6%) and mean number of admissions per limb as compared with OR (1.5 vs 1.9 vs 1.5).

In the second analysis of the early versus late era, there was an increase in number of limbs treated (121 vs 223). This institutional shift resulted in increased freedom from major amputation (87.4% vs 74.4%), reduced ICU stay (3.45 vs 16.98 hours), and shorter length of hospital stay (20.9 vs 31.5 days) between the early and late eras, reported the investigators in JEVT.