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Capstone

Percutaneous Peripheral Revascularization by Cardiologists: A 2 year Case Controlled Study at Inland Cardiology, Spoakne, WA

1 August 2000

Abstract

Chronic arterial insufficiency of the lower limbs is characterized by intermittent claudication often localized to the calf, buttock, or hip, and may present symptomatically shortness of breath and fatigue. Patients (pts) may have either uni- or bilateral pulse attenuation and thriss or bruit. These early clinical symptoms are the result of the atherosclerotic process of the vasculature of the lower extremities and kidneys. Renal hypertension may also be noted. Left untreated this may result in progressive renal failure. Treatment goals are to reduce ischemic pain and disease progression. One option is to treat patients to balloon Percutaneous Transluminal Angioplasty with a scaffolding stent (PTAS).

40 pts (23 male, 17 female, mean age 70.4 yrs range 51-71) were studied retrospectively from 68 procedures at Inland Cardiology in Spokane, WA. All pts failed conservative treatment. All pts were given a diagnostic workup and angiogram demonstrating >70% stenosis and a gradient >10%. All pts were diagnosed with either peripheral vascular disease (n=12, 30%) or artherosclerotic heart disease (n=28, 70%). Indications for intervention included intermittent claudication > 6 mo., limb ischemia, and resting pain. No pts were excluded from the study. Pts were followed at 1 mo, 3 mos, & annually. Pts all received the treatment of PTAS. Treatment outcome (wellness) was manipulated on the variables of restenosis rate, cardiac risk factors, secondary surgery, number of sites revascularized, ejection fraction, medications, and age. Data were treated with descriptive statistics, tests of correlation, and regression analysis with level of confidence set at 9 5%.

35 renal, 25 iliac, 5 femoral, & 3 subclavian arteries were revascularized. 18 pts had bilateral revascularization. 23 had secondary revascularization to contralateral or distal arteries. 5 pts had tertiary revascularization to distal or proximal arteries. 1 pt died 2 days post-op.

Technical success was 100%. Post-procedural angiogram data were available on 26/40 (65%) pts which showed widely patent stents in all but 1 (6%). That pt reported continued claudication symptoms & rest pain. 5/40 (12.5%) reported mild or intermittent claudication. There was a significantly better outcome for pts who had 0.05), but was causally related. A significant difference was found between the number who continued to symptoms (p0.05).

In conclusion, PTAS was shown to be a successful method of vessel reprofusion in this production. However, a statistically significant number of pts continue to have mild or intermittent claudication. Fewer than 3 peripheral sites revascularized was the best predictor of outcome. Additionally, hypertension may be causally related to outcome; yet not improve after revascularization.


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