In‐hospital outcomes of endovascular versus surgical revascularization for chronic total occlusion in peripheral artery disease

Zghouzi, Mohamed; Moussa Pacha, Homam; Ullah, Waqas; Sattar, Yasar; Ahmad, Bachar; Osman, Heba; Mohamed, Mohamed O.; Mir, Tanveer; Banerjee, Subhash; Shishehbor, Mehdi H.; Prasad, Anand; Rits, Yevgeniy; Mamas, Mamas A.; Alraies, M. Chadi

Abstract

Background
The outcome of endovascular intervention (EVI) compared vs. surgical revascularization in patients with peripheral artery disease (PAD) due to chronic total occlusion (CTO) is unknown.

Methods
Using the National Inpatient Sample database between 2007 and 2014, we identified all PAD patients with CTO who had limb revascularization. Multivariate analysis was performed to estimate the odds of in-hospital mortality and adverse outcomes between both groups.

Results
A total of 168,420 patients who had peripheral CTO and underwent limb revascularization were identified. 99,279 underwent EVI, and 69,141 underwent surgical revascularization. The patients who underwent EVI were younger, more likely to be women and African American, and less likely to be white (p < 0.001 for all). EVI was associated with lower in-hospital mortality (1.2% vs 1.7%, adjusted odds ratio [aOR]: 0.54; 95% confidence interval [CI] 0.50–0.59). The EVI group had higher vascular complications, major bleeding, acute kidney injury (AKI), and major amputation compared with surgical revascularization. A subgroup analysis on patients with critical limb ischemia showed lower mortality in the EVI group (1.4% vs. 1.9, aOR 0.56; 95% CI 0.50–0.63). Although there was no difference in the incidence of AKI or major amputation between the two groups, the EVI group had higher vascular complication rates and major bleeding events.

Conclusion
EVI in PAD with CTO is associated with lower in-hospital mortality, likely due to the procedure's less-invasive nature; however, it is associated with higher postprocedural complications likely due to the CTO's complexity.

Citation

Zghouzi, M., Moussa Pacha, H., Ullah, W., Sattar, Y., Ahmad, B., Osman, H., …Alraies, M. C. (in press). In‐hospital outcomes of endovascular versus surgical revascularization for chronic total occlusion in peripheral artery disease. Catheterization and Cardiovascular Interventions, 98(4), https://doi.org/10.1002/ccd.29827

• Journal Article Type: Article
• Acceptance Date: Jun 5, 2021
• Online Publication Date: Jun 23, 2021
• Deposit Date: Jun 23, 2023
• Journal: Catheterization and Cardiovascular Interventions
• Print ISSN: 1522-1946
• Electronic ISSN: 1522-726X
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 98
• Issue: 4
• DOI: https://doi.org/10.1002/ccd.29827
• Keywords: Cardiology and Cardiovascular Medicine; Radiology, Nuclear Medicine and imaging; General Medicine
• Additional Information: Received: 2021-04-22; Accepted: 2021-06-05; Published: 2021-06-23