Statins Improve Critical Limb Ischemia Outcomes After Endovascular Surgery

Newswise — CHICAGO– A retrospective study has revealed that statin therapy improves clinical outcomes after endovascular intervention in patients with critical limb ischemia (CLI), a severe form of peripheral artery disease (PAD) that usually requires treatment with bypass or endovascular surgery to prevent amputation. The report was authored by vascular and endovascular surgeons from New York - Presbyterian Hospital in New York City. Their research appears in the February issue of the Journal of Vascular Surgery®. “Patients who received statin therapy when they underwent interventions to treat CLI by lower extremity revascularization procedures showed significant improvement in overall survival, primary and secondary patency, and limb salvage rates,” said Francesco A. Aiello, MD from the divisions of vascular surgery at New York - Presbyterian’s Weill Cornell and / Columbia University Medical Centers.

“Our findings suggest that statins should be part of the periprocedural treatment regimen and support further investigation into their beneficial effects in patients undergoing endovascular treatment of CLI," said Dr. Aiello. “Statin therapy also has been associated with improved outcomes in patients with less severe forms of peripheral arterial disease.”

Researchers reviewed patient records from 2004 and 2009. There were 646 patients (904 limbs) who underwent lower extremity revascularization (1,469 lesions) for CLI. The patients were divided into two groups: 319 who were receiving statin therapy at intervention and 327 who were not and served as the control group. Demographics, lesion morphology, overall mortality, primary and secondary patency, and limb salvage were compared between the two groups. The statin and control groups did not differ significantly in age, sex, smoking history, hypertension, chronic renal and LDL levels.

The statin group had significantly higher rates of diabetes mellitus (DM), coronary artery disease, congestive heart failure, previous myocardial infarction (MI) and coronary artery bypass grafting (CABG). Dr. Aiello added that even though the prevalence of DM, CAD, congestive heart failure, history of MI, and CABG was significantly increased in the statin group, all-cause mortality was still significantly decreased in these patients at 12 and 24 months.

At 24 months, the statin-treated group had improved rates in many categories: primary patency (43 percent vs. 33 percent); secondary patency (66 percent vs. 51 percent); limb salvage (83 percent vs. 62 percent); and overall survival (77 percent vs. 62 percent).

Dr. Aiello said that this finding emphasizes the risk reduction potential of statin therapy and calls attention to the overall undertreatment of PAD patients compared with their CAD counterparts. He noted that lower prevalence of statin use has been seen in patients after hospitalization for acute MI or first-time lower extremity ischemia due to PAD, with a significantly smaller number of PAD patients being treated with a statin at the 6-month follow-up.

Researchers said they believe that despite increased recognition during the last decade of the need to initiate an appropriate statin regimen in all PAD patients, the prevalence of statin use in PAD patients still lags well behind the CAD population.

The clinical benefits of statins go beyond the cardiovascular protective effects seen in both operatively and conservatively treated patients with PAD, and in some studies it has been reported that statins also improved ABI, walking distance, and pain-free walking.

“Our findings have clear implications for clinical practice,” said Dr. Aiello. “CLI patients who are not already on a statin should be started on statin therapy before undergoing an endovascular intervention and continue the regimen afterwards.”

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About Journal of Vascular Surgery®

Journal of Vascular Surgery® provides vascular, cardiothoracic and general surgeons with the most recent information in vascular surgery. Original, peer-reviewed articles cover clinical and experimental studies, noninvasive diagnostic techniques, processes and vascular substitutes, microvascular surgical techniques, angiography and endovascular management. Special issues publish papers presented at the annual meeting of the Journal's sponsoring society, the Society for Vascular Surgery®. Visit the Journal Web site at http:www.jvascsurg.org/.

About the Society for Vascular Surgery®

The Society for Vascular Surgery® (SVS) is a not-for-profit professional medical society, composed primarily of vascular surgeons, that seeks to advance excellence and innovation in vascular health through education, advocacy, research, and public awareness. SVS is the national advocate for 3,350 specialty-trained vascular surgeons and other medical professionals who are dedicated to the prevention and cure of vascular disease. Visit its Web site at www.VascularWeb.org® and follow SVS on Facebook and Twitter.