claudication; bypass; angioplasty; Structured_Exercises
06/23/2014

discussion source:

Invasive Treatment for Infrainguinal Claudication Has Satisfactory 1 Year Outcome in Three out of Four Patients: A Population-based Analysis from Swedvasc. EJVES June 2014

using the Swedish registry, some 775 patients were identified who underwent intervention for claudication (IC). Those are their results: 
Improvement at 1 year was seen in 567 (73.2%) patients, (225 [77.6%] in the open surgery group, 320 [71.6%] in the endovascular treatment group, and 22 [57.9%] in the hybrid treatment group). 
No significant difference was found between the open surgery and endovascular treatment groups comprising 737/775 patients (p = .350). 
Hybrid treatment gave significantly worse results (p = .046). 
Fifty-seven (7.3%) patients reported unchanged limb function and 32 (4.1%) patients reported deterioration. 
Within 30 days two patients died and one patient underwent amputation. 
Within 1 year 10 patients underwent 11 amputations: five (1.7%) in the open surgery group, three (0.6%) in the endovascular treatment group, and two (7.5%) in the hybrid treatment group; one underwent bilateral amputation (p = .07). 
Twenty-two patients died: 10 (3.4%) in the open surgery group, 12 (2.7%) in the endovascular treatment group and none in the hybrid treatment group (p = .465).


My comments:

I do quote my patients a 2% risk of complication following endovascular intervention for IC, and 1% serious complication (amputaion, death, stroke, etc.). This is based on my audit of the Unit results (unofficial). This article from Sweden does reflect almost similiar results; but with death rate of 2-4% which is high. 
Would I consider/recommend intervention for IC: well, I do present those figures, discuss in MDT, excludes other pathologies, and give the patient time to think of their quality of life. If all fits, then yes I do offer intervention (this is standard practice in our unit), and usually the patient reaches the rest pain level before I do anything; therefore the risk of them losing their leg is 46% in 6 months (according to TASC II). 



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