Unexpected, late cardiovascular effects of surgery for peripheral artery disease. Veterans Affairs Cooperative Study 199
J. J. Bergan, S. E. Wilson, G. Wolf and R. H. Deupree
Pittsburgh [Pa] Veterans Affairs [VA] Medical Center.
In reviewing late morbidity of a multicenter clinical trial comparing
balloon angioplasty (percutaneous transluminal angioplasty) with bypass
surgery for lower-extremity ischemia, an unexpectedly high incidence of
adverse systemic events in surgical patients was uncovered. The study was
prospective and randomized, and included a total of 263 patients, with
follow-up from 2 to 6 years. When end points of related deaths,
amputations, and intervention failures were summed, surgery was favored
over percutaneous transluminal angioplasty at 4 years. Progression of
cardiac and renal dysfunction and mortality differed between groups. A
total of 42 deaths were in the group who underwent surgery and 27 in those
who underwent percutaneous transluminal angioplasty. The percentage
difference in death rate between the two groups increased each year to
reach 10% at 5 years. A significant difference in renal function was noted
in nine patients who underwent surgery and zero who underwent percutaneous
transluminal angioplasty. Myocardial infarctions were greater on follow-up
of surgical patients. After 6 years, congestive heart failure had occurred
in 19 patients who underwent surgery and eight who underwent percutaneous
transluminal angioplasty. The trends in this study of patients with only
moderately severe peripheral arterial disease suggest an increased rate of
deterioration of cardiac and renal function in patients who have arterial
operations. In surgical patients, mortality was 13.1% per year, whereas it
was 8.4% for patients treated with percutaneous transluminal angioplasty.
Future intervention studies should include long-term follow-up of such
cardiovascular events.
