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Invasive Treatment for Infrainguinal Claudication Has Satisfactory 1 Year Outcome in Three out of Four Patients: A Population-based Analysis from Swedvasc
Faculty of Medicine, Lund University, Lund, Sweden & Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden.
Vascular Centre, Skåne University Hospital, Malmö, Sweden.
Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden.
Research and Development Centre, Spenshult Hospital, Oskarström, Sweden.ORCID iD: 0000-0002-6294-538X
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2014 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 47, no 6, 615-620 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: In spite of recommendations advocating conservative best medical treatment, many patients with infrainguinal intermittent claudication (IC) are treated by invasive open and endovascular methods. This study aims to evaluate the incidence and 1-year results of all such treatments during 2009 in Sweden.

METHODS: The design was a one-year follow-up through the Swedish Vascular Registry (Swedvasc) of all 775 patients from the Swedish population of 10 million inhabitants in whom 843 invasive infrainguinal procedures (796 index procedures and 47 secondary procedures) were performed for IC in 2009. Index procedures were open surgery in 290 (37%) patients, bilateral in nine cases, giving a total of 299 limbs, endovascular treatment in 447 (58%) patients, bilateral in 10, giving a total of 457 limbs, and hybrid treatment in 38 (5%) patients, bilateral in two cases, giving a total of 40 limbs. Data were analysed both with regard to the number of patients (775) and the number of procedures (843). Clinical outcome was calculated from patient-reported leg function (unchanged, improved, deteriorated) and whether amputation had been necessary or death had occurred. Patent reconstruction at 1 year was also counted as improvement.

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).

CONCLUSIONS: Reported improvement at 1 year was 73.2% in patients invasively treated for infrainguinal IC. Patients reporting an unchanged or deteriorated clinical state are a considerable clinical challenge. Further studies to determine whether or not invasive treatment of infrainguinal IC is appropriate are justified. © 2014 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Place, publisher, year, edition, pages
London: Elsevier, 2014. Vol. 47, no 6, 615-620 p.
Keyword [en]
Infrainguinal, Peripheral arterial disease, Invasive treatment, Intermittent claudication
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hh:diva-27291DOI: 10.1016/j.ejvs.2014.02.005ISI: 000337661600007PubMedID: 24661922Scopus ID: 2-s2.0-84901634323OAI: oai:DiVA.org:hh-27291DiVA: diva2:772027
Note

This study has been possible through the participation of all Swedish vascular surgeons in Swedvasc, a grant, and the kind permission from the steering committee of Swedvasc to use registry data and a grant from the Gorthons foundation.

Available from: 2014-12-15 Created: 2014-12-15 Last updated: 2017-03-20Bibliographically approved

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CiteExportLink to record
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