Does preferential use of endovascular interventions by vascular surgeons improve limb salvage, control of symptoms, and survival of patients with critical limb ischemia?

Background: Our approach to patients with critical limb ischemia (CLI) underwent a rapid evolution from open surgery to preferential use of endovascular procedures. The goal of the current report was to evaluate the impact of this change on patients with CLI. Methods: Consecutive patients with CLI were compared between 3 periods: June 2001 to October 2002 (I) versus November 2002 to October 2003 (II) versus November 2003 to June 2005 (III). Results: A total of 275 patients (301 limbs, mean age 70 ± 11) underwent revascularization or primary major amputation (PA) for CLI (81 in I, 76 in II, 144 in III). PA decreased from 14.8%, 10.5%, and 3.5% (P < .001). Mean follow-up was 19.7 ± 13.6 months (range 0 to 57). Overall 24-month limb salvage (LS) was 60%, 69%, and 85% (P = .001), and 71%, 77%, and 88% following LS attempt (P = .017), with no difference in survival. Length of stay (LOS) decreased from 10.7 ± 12.1 (I) to 5.2 ± 6.2 days (III) (P = .001). Conclusions: Preferential use of endovascular interventions in patients presenting with CLI resulted in decreased number of PA, improved LS, and decreased LOS, without a difference in survival.