Cirugía endovascular como tratamiento de elección en el sector femoropoplíteo y distal en isquemia crónica de miembros inferiores en un servicio de angiología y cirugía vascular (1995-2001)

Summary Aim To analyse our experience in endovascular treatment of chronic arteriosclerotic ischemia of the lower limbs. Patients and methods Retrospective study of the period January 1995 to December 2001. 46 procedures (43 patients). Average age: 63.2 ± 10.2 years. Diabetes: 34.8%. Indication: critical ischemia, 80.4%. Disabling claudication: 19.6%. Topographical indication: type A-B lesions (n= 45) and type C (n= 1); stenosis, 54.3%, and occlusions, 45.7%. Run-off: 0-1 vessels, 39.1%; 2-3 vessels, 60.9%. Isolated angioplasty, 78.2%, and angioplasty+stent, 21.8%. Follow-up: 0.5-66 months (average, 19.1 months). We calculated the primary and secondary permeability, limb salvage and actuarial survival in terms of six variables: topographical sector, type of lesion, clinical degree, type of procedure, run-off and diabetes. Statistical tests: Kaplan-Meier, log-rank. SPSS statistical package. Results At 30 days: primary permeability, 93.4%; secondary, 95.6%; limb salvage, 93.4%. Survival, 100%. Late: overall primary permeability, 59.4% (run-off: 0-1 vessels, 40.3%; 2-3 vessels, 70.6%; p> 0.05; the rest of the variables are not significant). Overall secondary permeability, 66.6% (runoff: 0-1 vessels, 48.3%; 2-3 vessels, 78.6%; p> 0.05). There is no significant relation between the rest of the variables and secondary permeability. Overall limb conservation, 74% (claudicators, 100%; pain at rest, 85.8%; trophic lesions, 46.9%; p> 0.05. In run-off: 0-1 vessels, 19.7%; 2-3 vessels, 100%; p> 0.05). Overall survival, 80% at 5.5 years. Conclusions We consider endovascular surgery to be the first choice treatment in critical ischemia of the lower limbs with type A and B morphologies. In our series outlet drainage (2-3 vessels) is the most important prognostic factor for the success of this technique.