The Hospital Universitario de Navarra has released the results of an advanced endovascular technique that opens up a new therapeutic pathway for patients with advanced-stage arterial disease and with scarce surgical options, becoming in many cases the best alternative by avoiding amputation of the leg.
In this study, they managed to preserve the limb in 16 of the 19 patients treated through complex endovascular revascularization after the failure of previous surgeries. The data are presented at the X Simposio Internacional de Cirugía Endovascular, which takes place in Madrid from November 11 to 13.
The research has focused on people with critical limb ischemia, one of the most severe forms of peripheral arterial disease. This occurs when the arteries that carry blood to the legs suffer obstructions so significant that the supply of oxygen to tissues is insufficient.
In advanced stages, critical limb ischemia can cause pain even at rest, ulcers that do not heal, and lesions that threaten the viability of the leg. Loss of the limb is one of the most serious complications, both due to the deterioration of health and the impact on autonomy, mobility, and quality of life, and it is also associated with higher mortality.
Peripheral arterial disease is linked to the narrowing or blockage of the arteries, usually due to atherosclerosis. Its appearance is related to cardiovascular risk factors such as smoking, diabetes, arterial hypertension, and cholesterol disorders.
The Hospital Universitario de Navarra study has been aimed at a particularly complex group of patients: people with critical limb ischemia who already had surgery performed through femoro-popliteal or femoro-distal bypass with vein, in which this intervention had stopped being effective.
Bypass is a surgical technique that creates an alternative passage to maintain adequate blood flow to a specific area, in this case the leg. When this procedure fails, the options for repeating the surgery may be scarce and the risk of amputation increases noticeably.
In this context, specialists resort to complex endovascular techniques, with which they attempt to recanalize blocked arteries using catheters and other devices introduced through the vascular system, avoiding a new open surgery on the affected area.
The team at Hospital Universitario de Navarra has retrospectively reviewed the evolution of 19 patients, all of them men, treated between August 2022 and August 2026. The median age was 69 years and follow-up lasted around 20 months. During that time, 16 of the 19 patients kept the limb, which represents a limb-salvage rate of 84.2%, while the other three required a major amputation.
During follow-up, ten patients presented a new obstruction of the treated artery, although reinterventions made it possible to restore flow in several cases. At the end of the study, the secondary patency of the treated vessels reached 78.9%.
"This is not only about preserving a limb, but about preserving the patient’s quality of life, preserving their autonomy, and reducing the burden of care on family members or caregivers that an amputee patient entails," they warn. In addition, they recall that a major amputation is associated with higher mortality at 5 years, so avoiding these amputations can increase the survival of these patients.
The authors consider that the findings support considering complex endovascular recanalization as a possible alternative before indicating a major amputation in selected patients who have experienced the failure of a previous revascularization.
However, they emphasize that this is an observational study with a limited number of cases and that broader work will be necessary to confirm these results.