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Biomedical subjects

E Allaire

Publications and source records attributed to E Allaire.

At least 19 recordsLinked to original sources
PubMed1999

Surgical transluminal iliac angioplasty with selective stenting: long-term results assessed by means of duplex scanning.

PURPOSE: The safety of iliac angioplasty and selective stenting performed in the operating room by vascular surgeons was evaluated, and the short- and long-term results were assessed by means of serial duplex scanning. METHODS: Between 1989 and 1996, 281 iliac stenotic or occlusive lesions in 235 consecutive patients with chronic limb ischemia were treated by means of percutaneous transluminal angioplasty (PTA) alone (n = 214) or PTA with stent (n = 67, 23.8%). There were 260 primary lesions and 21 restenosis after a first PTA, which were analyzed separately. Stents were implanted in selected cases, either primarily in totally occluded arteries or after suboptimum results of PTA (ie, residual stenosis or a dissection). Data were collected prospectively and analyzed retrospectively. Results were reported in an intention-to-treat basis. Clinical results and patency were evaluated by means of symptom assessment, ankle brachial pressure index, and duplex scanning at discharge and 1, 3, 6, and every 12 months after angioplasty. To identify factors that may affect outcome, 12 clinical and radiological variables, including the four categories of lesions defined by the Standards of Practice Committee of the Society of Cardiovascular and Interventional Radiology, were analyzed separately. The statistical significances of life-table analysis of patency were determined by means of the log-rank test. RESULTS: There were no postoperative deaths or amputations. Local, general, and vascular complications occurred in 2.1%, 1.3% and 4.7% of cases, respectively (total, 8.1%). The mean follow-up period was 29.6 months. The cumulative patency rates +/- SE of the 260 PTAs (including 55 PTAs plus stents) were 92.9% +/- 1.5% at 1 month, 86. 5% +/- 1.7% at 1 year, 81.2% +/- 2.3% at 2 years, 78.8% +/- 2.9% at 3 years, and 75.4% +/- 3.5% at 5 and 6 years. The two-year patency rate of 21 redo PTAs (including 11 PTAs plus stents) was 79.1% +/- 18.2%. Of 12 predictable variables studied in the first PTA group, only the category of the lesion was predictive of long-term patency. The two-year patency rate was 84% +/- 3% for 199 category 1 lesions and 69.7% +/- 6.5% for 61 category 2, 3, and 4 lesions together (P =. 02). There was no difference of patency in the stented and nonstented group. CONCLUSION: Iliac PTA alone or with the use of a stent (in cases of occlusion and/or suboptimal results of PTA) offers an excellent long-term patency rate. Categorization of lesions remains useful in predicting long-term outcome. PTA can be performed safely by vascular surgeons in the operating room and should be considered to be the primary treatment for localized iliac occlusive disease.

Adult↗
PubMed1999

Indications and benefits of simultaneous endoluminal balloon angioplasty and open surgery during elective lower limb revascularization.

Combined balloon angioplasty and conventional revascularization are occasionally performed but some points are still controversial: which patients are eligible for this associated procedure?; should the procedures be performed simultaneously or successively?; and in case of simultaneous procedure, which one should be performed first? To answer these questions, the notes of 64 patients consecutively submitted to this procedure at the Henri Mondor hospital were reviewed. Arterial dilatation was performed on the iliac artery, superficial femoral artery, popliteal artery or tibioperoneal trunk in 31, 26, four and four patients, respectively. Reasons for simultaneous procedures were multiple occlusive lesions in 67% of patients and inflow improvement in 14%. The others reasons included iliac obstruction in poor risk patients, unilateral failure of planned bilateral iliac balloon angioplasty, outflow improvement, local contraindication to arterial approach, shortness of vein graft, clamp injury during open surgery and inadequate patient position for both procedures. Complications were rare. One patient died of recurrent sepsis of the femoro-femoral bypass. The 5-year limb salvage rate was 91%. In this study, simultaneous procedures were associated with three advantages: the risk of septic complications associated with graft implantations in a previously punctured site was decreased, anticoagulant and/or antiplatelet therapy did not need to be modified before the second procedure, hospital length of stay and cost appeared to be lower. On a simultaneous procedure, it is recommended that the balloon angioplasty be performed after the conventional procedure in order to avoid clamping a recently dilated artery when performing the bypass.

Adult↗
PubMed1999

Influence of diabetes on revascularisation procedures of the aorta and lower limb arteries: early results.

OBJECT: to evaluate the influence of diabetes mellitus on the therapeutic indications and the one-month results in patients with occlusive disease of the aorta and/or lower limbs arteries. MATERIAL: a retrospective study of fully computerised data of 1003 patients (753 men, 250 women) admitted consecutively to our vascular surgery unit over a 5-year period (1992-1996). Of the total, 169 were diabetics (group I) and 834 were non-diabetics (group II). Sixty-two per cent of patients in group I vs. 40% in group II presented with critical ischaemia or trophic changes (p<0.001). RESULTS: 15.4% of patients in group I vs. 4.1% in group II had primary amputation because of irreversible ischaemia or because arterial reconstruction was impossible. Of those who underwent revascularisation, 80% were infrainguinal in group I vs. 50% in group II. Forty-five per cent of patients in group I and 37% in group II had a percutaneous transluminal angioplasty (PTA) and approximately 3% in both groups had a combination of the two techniques. At one month, patients alive without major amputation numbered 64.4% in group I vs. 93.6% in group II, patients alive with major amputation numbered 26.6% in group I vs. 5.5% in group II, and mortality rates were 8.9% in group I vs. 0.8% in group II (P<0.001). CONCLUSIONS: the 5-times higher amputation and 10-times higher mortality rates for diabetics compared to non-diabetics call for better collaborative management of diabetics between general practitioners, vascular surgeons, diabetologists and cardiologists. PTA with a 90% initial success rate is indicated for short lesions even in the presence of limited gangrene.

Aged↗
PubMed1998

Local overexpression of TIMP-1 prevents aortic aneurysm degeneration and rupture in a rat model.

Although matrix metalloproteinases (MMPs) are expressed in abundance in arterial aneurysms, their contribution to arterial wall degeneration, dilation, and rupture has not been determined. We investigated MMP function in a rat model of aneurysm associated with arterial dilation, elastin loss, medial invasion by mononuclear inflammatory cells, and MMP upregulation. Rupture was correlated with increased gelatinase B (MMP-9) and activated gelatinase A (MMP-2). Syngeneic rat smooth muscle cells retrovirally transfected with tissue inhibitor of matrix metalloproteinases (TIMP)-1 cDNA (LTSN) or with the vector alone as a control (LXSN) were seeded onto the luminal surface of the vessels. The seeding of LTSN cells resulted in TIMP-1 local overexpression. The seeding with LTSN cells, but not LXSN cells, decreased MMP-9, activated MMP-2 and 28-kD caseinase and elastase activity, preserved elastin in the media, and prevented aneurysmal degeneration and rupture. We conclude that MMP overexpression is responsible for aneurysmal degeneration and rupture in this rat model and that local pharmacological blockade might be a reasonable strategy for controlling the formation of aneurysms in humans.

Animals↗
PubMed1998

Prevention of aneurysm development and rupture by local overexpression of plasminogen activator inhibitor-1.

BACKGROUND: Arterial aneurysms exhibit a loss of elastin and an increase in the plasminogen activators urokinase plasminogen activator (u-PA) and tissue plasminogen activator (t-PA). Because u-PA, t-PA, and plasmin have a limited proteolytic activity against elastin, the role of plasminogen activators in the aneurysmal disease is unclear. To investigate this question, we overexpressed plasminogen activator inhibitor-1 (PAI-1), an inhibitor of t-PA and u-PA, in a rat model of aortic aneurysm. METHODS AND RESULTS: Guinea pig-to-rat aortic xenografts were seeded with syngeneic Fischer 344 rat smooth muscle cells retrovirally transduced with the rat PAI-1 gene (LPSN group) or the vector alone (LXSN group). Some grafts were not seeded with cells (NO group). Western blots showed increased PAI-1 in grafts from the LPSN group compared with LXSN and NO groups. All grafts in the NO group (n=8) and 40% in the LXSN group ruptured between days 4 and 14. At 4 weeks in the LXSN group, the remaining unruptured grafts (n=6) were aneurysmal (diameter increase > or =100%), whereas in the LPSN group (n=6) none of the grafts had ruptured or were aneurysmal. Elastin was preserved in the LPSN group. t-PA, the major PA expressed in the model, was decreased in the LPSN group compared with the other groups, as determined by zymography. Quantitative zymography showed decreased levels of two matrix metalloproteinases (MMPs), a 28-kD caseinase, and activated MMP-9 in the LPSN group. CONCLUSIONS: The blockade of plasminogen activators prevents formation of aneurysms and arterial rupture by inhibiting MMP activation.

Animals↗
PubMed1998

Metalloproteinase blockade by local overexpression of TIMP-1 increases elastin accumulation in rat carotid artery intima.

We have recently demonstrated that the blockade of matrix metalloproteinases by local overexpression of the intrinsic inhibitor tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) reduces intimal hyperplasia. We now report a major change in the elastin content of the intima of rat carotid arteries seeded with TIMP-1-overexpressing smooth muscle cells. To understand the mechanism responsible for elastin accumulation, synthesis and degradation of elastin in TIMP-1 and control cell-seeded rats were measured. There were no differences in elastin mRNA or elastin synthesis, as documented by 14[C]proline incorporation between TIMP-1 and control cell-seeded arteries. In contrast, there was an increase in cross-linked elastin in the TIMP-1 group. In addition, in TIMP-1 and control rats, an elastase activity of approximately 28 kD was detected by elastin zymography and was decreased in TIMP-1 cell-seeded vessels. The 28 kD elastolytic activity was inhibited by exogenously added TIMP-1 and EDTA but not by PMSF, suggesting that it was a metalloelastase. Therefore, we have demonstrated that a shift of the proteolytic balance toward protease inhibition by TIMP-1 overexpression does not change elastin synthesis but rather changes posttranslational processing, resulting in increased elastin accumulation.

Animals↗
PubMed1998

Are femoro-infrapopliteal bypasses worthwhile for limb salvage?

OBJECTIVE: This study was performed in order to determine if: 1-- femoral bypasses ending below the popliteal artery are justified in aged patients or in patients with poor general conditions, 2-- if the use of prosthetic material is justified when no vein is available, 3-- if reintervention is beneficial in case of bypass occlusion. EXPERIMENTAL DESIGN: Retrospective study of 162 infrapopliteal bypasses followed during 1 to 12 years (mean: 1.5). SETTING: Vascular Surgery Department of the University Hospital Henri Mondor based in a suburb of Paris, France. PATIENTS: All patients who underwent a femoral bypass ending below the popliteal artery for limb salvage from January 1984 to December 1995. INTERVENTION: These bypasses were performed with a vein in 131 cases and with a PTFE graft (with or without distal cuff) in 31 cases. MEASURES: All patients were followed with clinical evaluation and duplex scan. Primary and secondary patency, limb salvage and patient survival were studied. The survival rates at 1 and 5 years were 87+/-3.8% and 66+/-9.6% respectively. Preoperative mortality was 7.4%. Renal insufficiency requiring dialysis, not age over 80, was associated with high perioperative mortality. RESULTS: The primary patency rates of the total series at 1 and 5 years were 55 and 35% respectively for the total series. For venous bypasses, it was 58 and 37% while for prosthetic bypasses, it was 49 and 15%. The secondary patency rates at 1 and 5 years were 67 and 46% for the total series. For venous bypasses, it was 70 and 49% and for prosthetic bypasses, it was 53 and 21%. Limb salvage rates at 1 and 5 years were 65 and 61% for the total series, 73 and 65% for venous bypasses and 48 and 41% for prosthetic bypasses. CONCLUSION: 1-- Femorotibial or peroneal bypasses are worthwhile for limb salvage even in aged patients but renal insufficiency requiring dialysis may justify primary amputation. 2-- If no vein can be used, prosthetic or composite bypasses should be performed because they are associated with a 41% limb salvage rate at 5 years. 3-- If thrombosis occurs, the increase of patency after re-operation is 12% in case of venous bypass and 6% in case of prosthetic bypass.

Adult↗
PubMed1998

[Surgery of subrenal abdominal aortic aneurysms. Impact of anatomic factors and of comorbidity on perioperative morbidity and mortality].

PURPOSE: To determine the predictivity of anatomic and co-morbid factors for peri-operative mortality of patients operated for a non-ruptured abdominal aortic aneurysm (AAA). METHODS: Between 1986 and 1996, data had been collected prospectively in a computerized date base. A chi-square test was performed for 5 anatomic, and 8 co-morbid criteria. RESULTS: 25 of 470 patients (5.3%) died within one month after surgery. Aneurysm diameter (P = 0.004) and aneurysmal internal iliac artery (P = 0.019) were associated with an increased mortality whereas upper extension of the disease necessitating a juxta-renal anastomosis, the need for inferior mesenteric artery reimplantation, or a symptomatic ilio-femoral occlusive disease, were not. Age (P = 0.016), obesity (P = 0.03), alteration of left ventricular function (P = 0.0014), and preoperative renal failure (P = 0.0001) were associated with increased mortality. CONCLUSION: Both anatomic and co-morbid factors can predict outcome after elective surgery for non-ruptured AAA. The criteria might help to selection patients who might benefit from endovascular treatment of AAA.

Aortic Aneurysm, Abdominal↗
PubMed1998

[Hypogastric arterial aneurysms associated with abdominal aortic aneurysms].

OBJECT: In a previous study, we have found that an operation for a combination of internal iliac aneurysms and an abdominal aortic aneurysm carries a heavier mortality than an operation for an abdominal aortic aneurysm alone. The object of this review was to define the prevalence of this combination of aneurysms and the results of the different treatment modalities in order to define the therapeutic choices. METHOD: A retrospective study of operations on 426 patients with asymptomatic infrarenal aortic aneurysms. The size of the iliac aneurysm was evaluated in terms of the calibre of the artery above and below the aneurysm and these size were classified as < 2C, = 2C and > 2C relative to that calibre. Three groups were defined: group 1--with at least 1 aneurysm < 2C: group 2--with at least 1 aneurysm = 2C, group 3--with at least 1 aneurysm > 2C. RESULTS: 32 patients had combined aneurysms (9 group 1, 13 group 2 and 10 group 3)--i.e. 7%. Treatment consisted of 23 exclusions by ligation, nearly all proximal, 6 bypasses of which 2 eventually required a ligation and 2 wrappings. Three patients aged 78, 82 and 86 years died, but no death was related to the treatment of the internal iliac aneurysms. On the other hand, massive haemorrhages occurred during the operation in a group 2 patient during an attempt at exclusion by ligation above and below the aneurysm and also in a group 3 patient during an unsuccessful attempt at bypassing. One further bypass proved impossible. Later, 2 group 3 patients developed postoperative complications: one buttock claudication and one invalidating paraplegia. CONCLUSION: It is justifiable not to operate on < 2C and, in some cases, = 2C, internal iliac aneurysms. Embolisation was not used in this series. Exclusion by ligation is a good procedure when the other internal iliac artery is patent. Bypassing is the ideal method in bilateral aneurysms but it is associated with the risk of venous haemorrhage and of thrombosis. When flow must be maintained in an internal iliac artery, our first choice is wrapping when the size is < or = 2C and endoneurysmorrhaphy + wrapping when the size is > 2C and performing a bypass may be risky. Unoperated internal iliac aneurysms should be periodically controlled with Duplex or CT scan.

Aged↗
PubMed1998

[Transluminal treatment of abdominal aortic aneurysms. Might one obstruct the renal arteries?].

During transluminal treatment of an aneurysm of the abdominal aorta, the proximal part of the stent may sometimes lay over the ostia of the renal arteries. Animal studies have shown various scarring patterns depending on the type of stent used and its duration of implantation. The Gianturco and Wallstent appear to be better tolerated than the Palmaz stents. The AA have shown that, with the Strecker stents, a neointima developed between the meshes of the stent over a surface of 43% +/- 30% in 6 weeks. May and Parodi report some occlusions in their clinical series. In the AA's series using Vanguard, no renal artery was thrombosed despite the fact that the stent lay over the artery on 2 occasions in 105 patients. In conclusion, the consequences of the proximal part of a stent laying over the ostium of a renal artery depend mainly on the type of stent used. "Wide mesh" stents are probably the best to use to prevent serious renal complications.

Animals↗
PubMed1997

Endothelial cell injury in cardiovascular surgery: the intimal hyperplastic response.

Arteries and veins respond to injury by a healing process that includes the development of a neointima. This response to injury is implicated as the primary cause of failure after arterial reconstruction. Because it is an integrator and transmitter of blood flow variations, inflammation, and growth stimuli, the endothelium is a potent regulator of long-term arterial wall mass changes. The contribution of the endothelium to intimal development depends on the type of arterial conduit. In arteries, the growth of the intima stops when the endothelium has regrown. In synthetic grafts, the endothelium stabilizes intimal growth. Hence, the mere presence of endothelial cells can influence intimal changes in arterial conduits. Understanding endothelial biology should help us define methods to prevent cell proliferation, extracellular matrix accumulation, intimal hyperplasia, and vessel narrowing.

Adaptation, Physiological↗
PubMed1997

Endothelial cell injury in cardiovascular surgery: atherosclerosis.

Most of the indications for cardiovascular operation and many of its complications are in large part due to advanced atherosclerosis. The pathogenesis of atherosclerosis involves inflammatory infiltration of the vessel wall, cellular proliferation, fibrous plaque formation, and ultimately plaque rupture and occlusive thrombosis. Many of these events are linked, at least initially, to chronic injury of the vascular endothelium. Endothelial cell injury from hypertension, diabetes mellitus, hyperlipidemia, fluctuating shear stress, smoking, or transplant rejection disrupts normal endothelial cell function. This results in the loss of the constitutive protective mechanisms and an increase in inflammatory, procoagulant, vasoactive, and fibroproliferative responses to injury. These changes promote vasospasm, intimal proliferation, and thrombus formation, all of which play a significant role in the initiation, progression, and clinical manifestations of atherosclerosis. Understanding the role of the chronically injured endothelium and its interactions with circulating immune cells and the underlying smooth muscle cells may lead to novel therapeutic interventions for the prevention and treatment of atherosclerosis.

Arteriosclerosis↗
PubMed1997

The immunogenicity of the extracellular matrix in arterial xenografts.

BACKGROUND: Determinants of xenograft immunogenicity are poorly characterized. We showed previously that decellularized arterial xenografts (DAXs) dilate, whereas decellularized arterial isografts (DAIs) and allografts do not, suggesting an interspecies, rather than an intraspecies, immunogenicity of the arterial extracellular matrix leading to chronic rejection. Now we have investigated the immunogenicity of the arterial extracellular matrix in xenografts and its impact on chronic injury (elastin lysis) and remodeling (graft dilation). METHODS: Diameter and elastin content were measured in DAIs and DAXs from hamster to rat (concordant combination) and guinea pig to rat (discordant combinations) at 8 weeks. We also characterized the immune effectors infiltrating DAIs and DAXs by immunohistochemistry after 6 hours to 4 weeks of implantation. Results were compared with nondecellularized isografts and xenografts. Last, the impact of the donor-recipient phylogenetic distance on monocyte-macrophage penetration into the media was assessed in three xenograft combinations. RESULTS: DAXs from guinea pig, but not from hamster, were aneurysmal at 8 weeks. Elastin lysis paralleled graft dilation. DAXs, but not DAIs, were infiltrated by monocytes, macrophages, T lymphocytes, and immunoglobulins. The donor-recipient combination did not affect the phenotype of the inflammatory infiltrate in DAXs, but it modified the kinetics of monocyte-macrophage penetration into the media. The absence of decellularization changed the inflammatory infiltrate phenotype (absence of macrophages) but had little impact on DAX injury and remodeling. CONCLUSIONS: DAX immunogenicity accounts for most of chronic arterial xenograft injury, which is modulated by the donor-recipient combination. The immunogenicity of arterial xenografts, unlike allografts, is supported by the extracellular matrix in addition to the cells and could influence the long-term fate of xenografts.

Aneurysm↗
PubMed1996

Cell and extracellular matrix rejection in arterial concordant and discordant xenografts in the rat.

Vascularized xenografts are rejected acutely and hyperacutely in concordant or discordant combinations, respectively. We investigated the impact of the donor-recipient combination on the rejection of arterial xenografts, analyzing the cellular and extracellular matricial compartments. Aortic xenografts were performed in a concordant (hamster) and a discordant (guinea pig) combination with Lewis rat. Graft cells and immune effectors were characterized by immunohistochemistry after 15 min and up to 30 days postimplantation. Macroscopic and microscopic structure of the grafts was studied at 60 days. IgC in the concordant combination and C3, C5b9, and IgM in the discordant combination deposited on endothelial cells, acutely and hyperacutely, respectively. The same immune effectors deposited on medial smooth muscle cells, but later than on endothelial cells. In both combinations the medial extracellular matrix was covered by IgM and IgC and infiltrated by monocytes (90%) and T lymphocytes (10%), with elastinolysis in the vicinity of monocytes. However, elastin resorption in the media at day 60 differed in concordant and discordant xenografts(75+/-10% and 99+/-1%, respectively). Intimal thickening and aneurysm developed in concordant and discordant combinations, respectively. Unlike arterial allografts, arterial xenografts are not a homogeneous group. The donor-recipient combination determines the mechanism and the timing of graft cell rejection, as well as the magnitude of medial elastin injury. As a consequence, chronic graft remodeling differs in the two combinations.

Acute Disease↗
PubMed1996

[Impregnated polyester prostheses: a theoretical advantage].

Leak-proof polyester grafts impregnated with collagen, gelatine or albumin are routinely used in vascular surgery. Theoretically, there are several advantages: no need for pre-coagulation, reduced operation time and graft manipulation, less blood loss during the operative period, better healing with a potentially greater resistance to infection. We analyzed all the publications in scientific journals to verify whether these theoretical advantages are validated by clinical trials. There have been 12 non-comparative series reporting favourable results but the lack of control groups makes it difficult to draw conclusions. Five comparative series with random assignment of patients have been reported. None of these series showed a substantial benefit from impregnation. Thus the use of an impregnated polyester graft would not appear to be justified for routine standard aorto-iliac surgery. Conversely, although no evidence has been provided by a comparative study, the major risk of haemorrhage in procedures such as extra-corporal circulation, the thoracic or abdominal aorta and in patients with a coagulation disorder, impregnated graft probably constitute an important progress.

Albumins↗
PubMed1995

Conventional versus endovascular surgical procedures: a no choice option.

The on-going debates on the competitiveness of endovascular and conventional surgery in the treatment of peripheral occlusive vascular diseases are justified by the fact that endovascular procedures are associated with a lower mortality and morbidity, require a shorter hospital stay, and are less costly than conventional surgery. However, scientific and economic comparisons between the two techniques are difficult because they cannot strictly be applied to the same patients. Patients who may benefit from endovascular surgery are generally at an earlier stage of the disease, they have claudication and short stenoses or occlusion. On the other hand, patients who present with severe claudication or critical ischaemia, in most cases, have long occlusions, multiple segmental disease and often require conventional surgery.

Angioplasty, Balloon↗
PubMed1995

Iliac and femoropopliteal lesions: evaluation of balloon angioplasty and classical surgery.

PURPOSE: The purpose of this study was to compare the characteristics of patients treated for atherosclerotic disease of the lower extremities with balloon angioplasty (BA) or classical surgery (CS) and to assess the outcome of both techniques. METHODS: The records of 1364 patients who were treated with BA or CS for chronic lower limb ischemia between 1986 and 1993 were analyzed. Demographic features of patients, immediate and long-term survival, patency, and amputation rates were compared in both groups according to the level of the revascularization (iliac or femoropopliteal). RESULTS: Patients undergoing BA were slightly younger (62.3 years versus 65.9 years for CS group; p = NS) and demonstrated symptoms consistent with less severe atherosclerotic disease (81% claudication in the BA group versus 48% in the CS patients; p < 0.001). At 30 days post-treatment in the BA and CS groups, respectively, there were 0.7% and 4% deaths (p < 0.01); 13% and 6% primary failures (p = 0.013); 13% and 6% secondary failures (p = 0.01); 0.3% and 12% general complications (p = 0.001); and 3% and 8%, nonvascular complications (p = 0.007). At the iliac level, in the angioplasty (n = 134 limbs) and surgery (n = 721 limbs) groups, respectively, the mean age was 57.6 and 63.7 years (p < 0.01), and claudication was present in 91% and 72%. Perioperative mortality was 0% and 1.9%. The 4-year survival rates were 95% and 88%; patency was 70% and 79%; and the amputation rates were 0% and 5%. At the femoropopliteal level, in the angioplasty (n = 138 limbs) and surgery (n = 656 limbs) groups, respectively, the mean age was 67.8 and 66.8 years (NS), and claudication was present in 69% and 28%. Perioperative mortality was 0.9% and 5.5%. The 4-year survival rates were 95% and 78%; and patency was 44% and 65%. At 2 years, the amputation rates were 6% and 12%. CONCLUSIONS: Patients treated by BA were younger, especially in the iliac group, and had less symptomatic lesions than patients treated with surgery. Surgery achieved a better long-term patency at the cost of a higher immediate complication rate and mortality. Whenever technically feasible, BA may be the better choice for initial therapy in appropriate patients suffering from chronic lower limb ischemia.

Aged↗