SLR - December 2012 - DiStefano

Comparison of Initial Hemodynamic Response after Endovascular Therapy and Open Surgical Bypass in Patients with Diabetes Mellitus and Critical Limb Ischemia

Reference: Zhan, LX.  Bharara, M. White, M.  Bhatnagar, S. Lepow, B.  Armstrong, DG.  Mills Sr, JL. Comparison of Initial Hemodynamic Response after Endovascular Therapy and Open Surgical Bypass in patients with Diabetes Mellitus and Critical Limb Ischemia. J Vasc Surg 2012; 56: 380-6. 

Scientific Literature Review

Reviewed by: Danielle DiStefano, DPM
Residency: University Hospital – UMDNJ, Newark, NJ

Podiatric Relevance:
Patients with concomitant diabetes and critical limb ischemia are often complex and problematic to treat since healing potential is greatly impaired and severe tissue loss may be present. Vascular intervention is seemingly the only option in maximizing arterial circulation to the foot in an effort to the heal ulcerations or amputations. 

Methodology consisted of a retrospective chart review of patients undergoing endovascular revascularization or open bypass procedures between 2006 and 2010 that also had a diagnosis of diabetes mellitus, critical limb ischemia and had pre- and post-procedure hemodynamic data. Ankle-brachial indices (ABI) and toe pressures were assessed pre-intervention and at six weeks post-intervention. Incidence of a major amputation (AKA or BKA) was followed until approximately one year post procedure.

When comparing endovascular revascularization and open bypass procedures, there was no statistically significant difference between interventions in examined outcome measures. Both groups showed similar increases regarding absolute and percentage changes in ABIs and toe pressures at six weeks follow-up; similarly, the major amputation rate yielded 11 percent incidence in each group by the time of last follow-up.

Both endovascular and open bypass interventions generated similar hemodynamic results within six weeks of the intervention. Major amputation rate at approximately one year’s time was also similar amongst both groups. Although long term outcomes tend to favor open bypass, further clinical trials are needed to elucidate differences between these interventions. 

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