J Korean Surg Soc.  2013 Jun;84(6):353-359. 10.4174/jkss.2013.84.6.353.

Role of surgical treatment for peripheral arterial disease in endovascular era

• Park SJ
• Hwang JC
• Cho HR
• Park HJ
• Kim SJ
• Park BW

• KMID: 1505185
• DOI: http://doi.org/10.4174/jkss.2013.84.6.353

Abstract

PURPOSE
The purpose of this study is to review the roll changes of surgical treatment for peripheral artery disease in endovascular era.
METHODS
One hundred and twelve surgically treated cases of peripheral artery disease at a single institution during the period from 2006 to 2011 were studied retrospectively. The cases were divided into two groups of different time periods, one before 2009 (surgical period group) and the other from 2009 onward (endovascular period group). We analyzed the type and location of surgery as well as clinical characteristics of patients and treatment results.
RESULTS
Fifty-three cases were for the surgical period group and 59 cases for the endovascular group. No difference in the demographic characteristics and the distribution of major atherosclerosis risk factors was found between the two groups. Additionally, the technical and functional success rate was similar in both groups. However, it is found that there were more acute cases in the endovascular period group than in the surgical period group. The number of cases in need of suprainguinal or below knee exposure was similar in both groups. In hybrid cases, suprainguinal or below knee exposures were more frequently needed during the former period than the latter period.
CONCLUSION
The role of surgical treatment is currently in the process of changing. Surgical treatment seems to be a complementary alternative to endovascular treatment for chronic limb ischemia. However, it still seems to play a major role for acute limb ischemia.

Keyword

Peripheral arterial disease; Hybrid; Thrombectomy; Embolectomy

MeSH Terms

Atherosclerosis
Chimera
Embolectomy
Extremities
Humans
Ischemia
Knee
Peripheral Arterial Disease
Retrospective Studies
Risk Factors
Thrombectomy

Figure

• 

  Fig. 1 Annual number of treatment cases for peripheral arterial disease.

Reference

1. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg. 2007. 33:Suppl 1. S1–S75.

2. Kim MS, Joo YS, Park KH. Results of simultaneous hybrid operation in multi-level arterial occlusive disease. J Korean Surg Soc. 2010. 79:386–392.

3. Dormandy JA, Rutherford RB. TASC Working Group. TransAtlantic Inter-Society Consensus (TASC). Management of peripheral arterial disease (PAD). J Vasc Surg. 2000. 31(1 Pt 2):S1–S296.

4. Aslam F, Haque A, Foody J, Lee LV. Peripheral arterial disease: current perspectives and new trends in management. South Med J. 2009. 102:1141–1149.

5. Perera GB, Lyden SP. Current trends in lower extremity revascularization. Surg Clin North Am. 2007. 87:1135–1147.

6. Gray BH, Conte MS, Dake MD, Jaff MR, Kandarpa K, Ramee SR, et al. Atherosclerotic peripheral vascular disease symposium II: lower-extremity revascularization: state of the art. Circulation. 2008. 118:2864–2872.

7. Hiromatsu S, Sakashita H, Okazaki T, Onitsuka S, Tanaka A, Fukunaga S. Perioperative outcomes for elective open abdominal aortic aneurysm repair since the adoption of endovascular grafting procedures. Eur J Vasc Endovasc Surg. 2011. 42:178–184.

8. Results of a prospective randomized trial evaluating surgery versus thrombolysis for ischemia of the lower extremity. The STILE trial. Ann Surg. 1994. 220:251–266.

9. Adam DJ, Beard JD, Cleveland T, Bell J, Bradbury AW, Forbes JF, et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005. 366:1925–1934.

10. American College of Cardiology Foundation. American Heart Association Task Force. Society for Cardiovascular Angiography and Interventions. Society of Interventional Radiology. Society for Vascular Medicine. Society for Vascular Surgery. 2011 ACCF/AHA focused update of the guideline for the management of patients with peripheral artery disease (updating the 2005 guideline). Vasc Med. 2011. 16:452–476.

11. Mahmud E, Cavendish JJ, Salami A. Current treatment of peripheral arterial disease: role of percutaneous interventional therapies. J Am Coll Cardiol. 2007. 50:473–490.