Endo first is not appropriate in some patients with critical limb ischemia because "bridges are burned"

BACKGROUND: The aims of this study were to determine the effect of failed prior endovascular treatment (EV) on early and midterm outcomes of subsequent lower extremity open surgical bypass (OS). METHODS: Patients undergoing infra-inguinal bypass for CLI from January 2008 to December 2011 were retrospectively reviewed. The results after first-line bypass and bypass after failure of EV treatment were compared. A total of 213 patients (65.25% males, average age 73.30 yrs.) underwent bypass. OS patients were then divided into 2 groups: group 1 consisted of 138 patients who underwent primary OS for CLI without prior EV (control group), and group 2 consisted of 75 patients who had OS following a failed attempt at elective EV for peripheral vascular disease. Of the 213 bypass performed, 34% had a prior infra-inguinal failed EV. The primary study endpoints were early and 1-year major amputations and graft occlusion. The secondary outcomes included early and 1-year mortality and the level of distal revascularization. RESULTS: Secondary patency and limb salvage rates were significantly better in group 1 up to 1 year (99% vs. 86%, P < .001 @ 1 months, and 95% vs. 76%, P < .05 @ 12 months, respectively). CONCLUSION: Previous failed EV should be predictive of poor outcome in patients undergoing distal OS for CLI.