Bypass Surgery Becoming More Common for PAD

Peripheral artery disease patients more likely to receive bypass surgery but survival unchanged

(RxWiki News) Peripheral artery disease (PAD) patients are now more likely to receive lower extremity bypass surgery to open clogged arteries in their legs. Despite the increase, survival rates remain unchanged.

Researchers also found that the number of adverse heart events that patients suffer after the procedure has not declined.

"Ask your cardiologist about procedures that are appropriate in your scenario."

Philip P. Goodney, MD, MS, coauthor and a vascular surgeon from the Dartmouth-Hitchcock Medical Center, noted that the observational change in the practice pattern for PAD patients could, in part, be related to surgeons feeling obliged to perform bypass surgery if a prior artery-opening surgical procedure using a balloon catheter, also called angioplasty, is not successful.

During the study, investigators reviewed Vascular Study Group of New England data between 2003 and 2009 regarding 2,907 patients. Of those patients, 72 percent had critical limb ischemia (CLI), a severe limb-threatening form of PAD, while the remainder received treatment for intermittent claudication (IC), identified by pain, cramping, numbness and fatigue in the calf, most commonly from PAD. IC can later progress to CLI.

Investigators found that bypass surgery for IC increased substantially during the study period, from 19 percent to 31 percent. A significant proportion of patients also received bypass surgery after a previous angioplasty procedure.

Among CLI patients, the percent receiving bypass surgery jumped from 11 percent to 24 percent, while among IC patients it increased from 13 percent to 23 percent.

However, after one year of follow up, there was no significant change in amputation-free survival. Among IC patients, 97 percent survived without amputations in 2003, compared to 98 percent in 2008, while 73 percent of CLI patients were still alive without receiving an amputation in 2003 versus 81 percent in 2008.

There were also no significant changes found when investigators examined in-hospital mortality, the number of bypass grafts that become reclogged or adverse cardiovascular event rates.

Investigators said that while bypass is still more commonly performed for CLI, a larger percentage of IC patients are now receiving the surgical circulation restoration procedure.

Additional information about PAD patients receiving only angioplasty could help investigators better identify the trends and find methods for better determining patients that could benefit from each of the procedures.

The research was recently published in the June issue of the Journal of Vascular Surgery.

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Review Date: 
May 24, 2012