SAFETY OF ENDOVASCULAR TREATMENT IN HIGH-CARDIAC-RISK PATIENTS WITH LIMB-THREATENING ISCHEMIA

Vascular surgery can be safely performed in approximately 60% of patie nts with advanced peripheral vascular disease, because of the high fre quency of concomitant coronary artery disease and consequent increased risk of perioperative cardiac complications. The aim of this study wa s to validate the hypothesis that endovascular revascularization could be safely applied to high-cardiac-risk patients with a lower incidenc e of perioperative cardiac complications. One hundred and fourteen pat ients with peripheral vascular disease referred for revascularization underwent preoperatively a clinical and echocardiographic evaluation, at rest and under dipyridamole stress test, to assess the cardiac risk . Patients with high clinical score (according to Goldman and Detsky), or low left ventricular ejection fraction at rest, or positive dipyri damole stress test, were considered at high cardiac risk. To record ad verse cardiac events, all patients were monitored during surgery, post operatively, and followed up for 18 months after hospital discharge. F orty-eight patients (42%) were found to be at high cardiac risk. In th is high-cardiac-risk group, endovascular surgery was performed in 37/4 8 patients (77%) (group A), while the remaining 11/48 patients (23%) w ere bypassed with open surgery (group B). Postoperative cardiac compli cations occurred in 16% of patients in group A and in 45% of patients in group B with two deaths (p < 0.05). At follow-up, 51% of patients i n group A and 44% of patients in group B had suffered late cardiac eve nts (p = ns), with 10 deaths in group A and three deaths in group B (p = ns). Limb salvage rate was similar in the two groups (95% group A, 100% group B; p = ns), These data show that high-cardiac-risk patients with limb-threatening ischemia have significantly less perioperative cardiac complications when treated by endovascular procedures instead of bypass surgery. Follow-up data on cardiac events confirm the severi ty of concomitant coronary artery disease in patients with peripheral vascular disease.