The role of surgical intervention in the treatment of Peripheral Arterial Disease.

The role of surgical intervention in the treatment of Peripheral Arterial Disease. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The role of surgical intervention in the treatment of Peripheral Arterial Disease. Lilas Alhamad, Muhammad Assem Kubtan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3985488/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Aim and background: The increase of peripheral arterial disease (PAD) to an estimated 200 million patients along with its life-limiting symptoms and the complications of treatment with traditional open surgery; builds a need to advance interventional intravascular procedures treatment. This study aims to accentuate the role of interventional intravascular procedures on PAD patients. Methods and material: A Cross-sectional retrospective study. The study was performed on 500 patients who were admitted at Damascus hospital for interventional intravascular procedure, during the period 14-1-2015 to 5-9-2023. A questionnaire was designed to include demographic data, initial clinical presentation, diagnosis, patient history, type of intravascular procedure, medication, duration of hospitalization and patient complications. Result: The majority of patient who are 194 patients were in the age group of 60–70 years, representing 39%. The male patients were 402 patients, accounting for 80%. The most common complaint among patients was pain representing 30%. 171 (23%) patients had a superficial femoral artery complaint and were the most frequently subjected arteries to interventional procedures.The largest number of patients, 410 patients, spent only one day in the hospital representing 82%. The most common complication among patients was stent occlusion, with 35 patients (7%). There was a strong statistically significant relationship between the gender of the patient and the procedure involving balloon angioplasty and a significant relationship between the Kissing procedure and patients' age. Conclusion: This study shows the importance of interventional procedures in treating peripheral vascular disease compared to conventional surgery. However, interventional intravascular procedure remains the surgical intervention which has its own complications, and studies on the benefit of the interventional procedure are still insufficient. Surgery Peripheral arterial disease Interventional vascular procedures Intermittent Claudication Introduction Peripheral arterial disease (PAD) is defined as a decrease in arterial perfusion due to stenosis or occlusion in the vessels, especially in the lower limb. The main cause is usually due to the presence of atheroma. 1 The clinical manifestations of PAD are categorized into three classifications: Asymptomatic, intermittent claudication, and critical limb ischemia. 2 Therefore, management depends on the condition of the disease and the severity of symptoms, as treatment options include: Lifestyle changes, pharmacological therapy, interventional intravascular procedures and traditional open surgery. 1 The gold standard for the management of PAD is by traditional open surgery, but with the new advancement in interventional intravascular procedures treatment, using Vascular Catheterization has become the new unconventional recommended procedure. Which reduces the complications of open surgery and duration of hospitalization. Also, in the future, it is expected to have a positive role in reducing morbidity and mortality. 3 Methods and Materials Study design: A retrospective cross-sectional study was conducted to accentuate the role of interventional intravascular procedures on PAD patients who were hospitalized in Damascus Hospital during the period 14-1-2015 to 5-9-2023. Patients: The study included 500 patients diagnosed with PAD who were admitted to Damascus Hospital. Methods: The patient’s record was used to fill out a questionnaire by the following criteria. Inclusion criteria: all PAD patients who undergo interventional intravascular procedures. Exclusion criteria: cases with damaged patient records or with incomplete data, cases in which interventional intravascular procedure was preformed on central arteries and cases only managed by digital subtraction angiography were excluded from the study. data were extracted based on the questionnaire design which included: demographic data, initial clinical presentation, diagnosis, patient history, type of intravascular procedure, medication, duration of hospitalization and patient complications. statistical analysis: The collected data from the questionnaire were filled into an Excel file and statistical data analysis was performed using Package for the Social Sciences Statistical (SPSS) version 25. Furthermore, we considered a predictive value of less than 0.05 (p values < 0.05) as a statistically significant value. Descriptive statistics were represented by studying the distribution of the sample according to the study variables along with the measures of central tendency (arithmetic mean and standard deviation). We used the Chi-square test to test statistically the relationships between basic characteristics by comparing the categorical variables with normal distribution. Ethical consideration: Ethical approval was obtained from the Institutional Review Board (IRB) Faculty of Medicine, Syrian Private University. Results The study included 500 patients with the peripheral arterial disease (PAD). 402 of whom were male (80%), while 98 of them were female (20%). Patients ages was ranging from 20–90 years. There were only 2 patients (0. 4%) in the age group of 20–30 years, while there were 9 patients ( 2%) in the 30–40 age group. 50 patients (10%) were in the age group between 40–50 years. There were 115 patients ( 23%) aged 50–60. The largest number of patients, amounting to 194 patients, were in the age group of 60–70 years representing 39%. As for patients in the age group of 70–80 years, there were 119 patients (24%). Finally, there were 11 patients ( 2%) in the 80–90 age group. Among these patients, there were 285 smokers ( 57% ) and 44 former smokers (9%). The non-smoker patients were 171 ( 34%). As for alcohol consumption, there were only 10 patients ( 2%) who consumed alcohol, while 3 patients (1%) were occasional alcohol consumers. The rest of the patients did not consume alcohol, totaling 489 patients, representing 97%. As for the main complaint, 9 patients had pallor (1%), while sensory disturbances occurred in 26 patients ( 2%). Discoloration was observed in 88 patients ( 6%). The non-healing ulcers were reported by 124 patients ( 8%). Cold extremities, numbness and paresthesia were common complaints in 191 and 252 patients at rates of 12% and 16%, respectively. Additionally, 415 patients ( 26%) suffered from intermittent claudication. The most common complaint among the patients was pain, reported by 479 patients, representing 30%. 96 of the patients (19%) were diagnosed with ischemia of both lower limbs. While 201 of the patients (40%) had left lower limb ischemia. Finally, 203 patients (41%) had right lower limb ischemia. Referring to the history of the sample patients, we found that 16 and 17 patients had heart failure and kidney failure by 2% each. 22 patients ( 3%) had ischemic heart disease. 42 patients ( 5%) had a cerebral vascular accident. 277 patients (34%) had arterial hypertension. Most of patients had diabetes, totaling 369 patients, representing 45%. In contrast, 83 patients had no medical history representing 10%. For medication history, 6 patients took proton pump inhibitors and alpha-blockers at a rate of 1% for each, while 19 and 20 patients took antibiotics and vitamins at a rate of 2% for each. Beta-blockers were consumed by 25 patients (3%). As for 42 patients( 5%), diuretics were part of their medication history. 65 patients (7%) were taking pentoxifylline. Additionally, 118 patients were on triple therapy (aspirin, clopidogrel, atorvastatin) at a rate of 13%, while 127 and 186 patients were taking cardiovascular drugs and platelet antiaggregants at rates of 14% and 20% respectively. Finally, most patients, totaling 299, were taking lipid-lowering agents representing 33%. Upon reviewing the family history of the patients, 5 patients (1%) had a mother who had diabetes, while only one patient (1%) had a sister who had diabetes. For the rest of the 494 patients (99%) in the sample, they did not have family history of diabetes. Regarding allergic history, penicillin allergy was found in 4 patients (1%), while there were no other allergic histories in the rest of the 496 patients (99%). In terms of surgical history of patients, two patients underwent hernia repair and hemodialysis catheterization, each at a rate of 0.4%, while 8 patients (1%) underwent hernia repair. Additionally, 17 patients underwent gallbladder removal, angiography, and lower limb amputation each at a rate of 3%, while 24 patients (4%) underwent appendectomy. Furthermore, 41 patients (7%) underwent peripheral artery widening. 54 patients ( 10%) underwent coronary artery bypass grafting (CABG). 63 patients ( 11%) underwent percutaneous coronary intervention. The remaining patients, totaling 251, did not undergo any surgical procedure at a rate of 45%. Drug therapy with stenting was one of the interventional procedures performed on 3 patients (1%), while the kissing procedure was done on 79 patients (15%). Balloon angioplasty was performed on 158 patients (30%). A combination of balloon angioplasty and stenting was carried out on 285 patients (54%). Only 2 patients were intervened in the internal iliac artery and the deep femoral artery, each in at a rate of 0.2%. Intervention on the common femoral artery was done in 8 patients (1%). Intervention on the tibiofibular trunk in 11 patients (2%). The intervention on the external iliac artery occurred in 49 patients ( 7%), and on the popliteal artery in 54 patients ( 7%). For 69 patients ( 9%), the intervention occurred on the posterior tibial artery, and the intervention occurred on the two common iliac arteries on both sides, in 79 patients (11%). The anterior peroneal and common iliac arteries were among the arteries that were intervened in 80 and 89 patients, at a rate of 11% and 12%, respectively. The anterior tibial artery was also intervened in 114 patients (16%). Finally, the superficial femoral artery was the most frequently interfered with in 171 patients (23%). Upon reviewing the medications that the patient was followed up on after the interventional intravascular procedure, Apixaban was prescribed for only one patient (0.2%). Meanwhile, proton pump inhibitors and triple therapy (aspirin with clopidogrel and atorvastatin) were prescribed for 14 patients each at a rate of 3% for each. Enoxaparin was prescribed post-surgery for 16 patients (3%). Glycans therapy was prescribed for 26 patients (5%), while triple therapy with antibiotics and analgesics was prescribed for 89 patients (18%). The majority of patients, totaling 372 patients, were put on triple therapy after surgery at a rate of 74%. The majority of patients, 410 out of 500, stayed in the hospital for only one day, accounting for 82%. Whereas, 34 patients (7%) stayed for two days. Additionally, 21 patients (4%) remained for three days. As for the remaining patients, totaling 35, their hospitalization lasted four days or more, comprising 7%. The outcome of these surgical interventions and therapeutic procedures was death in 8 patients (2%), while 58 patients (12%) showed improvement with the development of some complications. The rest of the patients, totaling 434, improved, representing 87%. Postoperative complications resulting from interventional intravascular procedures included stent leakage and the development of a hematoma in only one patient (0.2%). Arterial dissection occurred in two patients (0.3%). 3 patients had pseudoaneurysm developed, also 5 patients experienced infections and emboli with a rate of 1% each. Atrial fibrillation occurred in 7 patients (1%). 8 patients suffered from bleeding and 9 experienced acute kidney failure with a rate of 2% each for both complications. The most common complication among patients was stent occlusion, with 35 patients experiencing this complication at a rate of 7%. By studying the relationship between the type of interventional procedure and its outcome on the patient, we did not find a statistically significant relationship. The results were similar among patients. Of the patients who underwent the Kissing procedure, 15% showed improvement, while complications occurred in 13%, and 25% passed away. The P value of 0.770 indicates no significant correlation between these two variables. Similarly, for the rest of the interventional procedures, the proportions of patients in all interventions were similar and the P value > 0.05 indicating no strong statistical relationship between the outcome of the interventional procedure and its type on the patient. In studying the relationship between interventional procedures and duration of hospitalization, we did not find statistically significant relationships between these variables. For example, in the case of balloon angioplasty, the percentages of the duration of hospitalization were similar, resulting in a P value of 0.860, indicating a lack of a strong significant relationship between these two variables. Similarly, for the rest of the interventional procedures and their impact on the duration of hospitalization, the percentages were similar, resulting in P values > 0.05, indicating a lack of statistically significant relationships between these variables. By studying the relationship between interventional procedures and the gender of the patient, we found a strong statistically significant relationship between the gender of the patient and the procedure involving balloon angioplasty. There were 133 males who underwent this procedure representing 28%, while 45 female patients accounting for 46%. The P value reached 0.0074, indicating a significant relationship between these variables. As for the rest of the interventional procedures and their relationship with gender, we did not find a significant relationship between them and the gender of the patient. The proportions of both genders undergoing the other three interventional procedures were similar, with a P value > 0.05 indicating no strong statistically significant relationship between these variables. By examining the relationship between interventional procedures and patients' age, we found a statistically significant relationship between the Kissing procedure and patients' age, where the majority of patients who underwent this procedure were between 30–40 years old, with a P value of 0.0008, indicating a significant relationship between these two variables. There was also a statistically significant relationship between balloon angioplasty and the age of the patients, with a P value of 0.0008. As for the rest of the procedures, we did not find a relationship between them and the age of the patients, as the proportions of these procedures were similar among all ages of the sample, with P values > 0.05, indicating that there is no significant relationship between these variables. Discussion The prevalence of PAD is estimated at approximately 200 million. 4 Claudication is the most common lifestyle-limiting symptom of PAD. A significant portion of patients with PAD develop pain or ulceration at rest and subsequent need for amputation. 4 , 5 Critical limb ischemia (CLI) is particularly common in diabetic patients and in patients with arterial calcification. It occurs mainly in the infrapopliteal (IP) vessels and less commonly in the femoropopliteal (FP) artery. In contrast, to claudication that occurs Commonly due to lesions in the FP artery. 6 , 7 Many traditional risk factors such as hyperlipidemia, diabetes, high blood pressure, smoking history, and obesity are strong risk factors for developing PAD in both genders. 8 Even though the prevalence of PAD is similar or higher in women than in men, the associations of traditional and nontraditional risk factors with PAD and the clinical manifestations of PAD differ by sex and may contribute to delayed or underdiagnosis in women. 8 These results differed from the results in our study, as the percentage of males with PAD was higher than the percentage of females (80% versus 20%). This difference may be due to the increased risk factors in our study among males compared to females, in terms of smoking and aging. In contrast, the prevalence of PAD in post-menopausal women increases, 9 and a woman's risk of incidental vascular disease is determined by the risk factors present during the post-menopausal period. 10 Smoking is the main preventable cause of PAD in women, especially for those under 50 years of age. Also, in general, patients who smoke are at a four-fold increased risk of developing symptoms of PAD compared to non-smokers. 11 These results were similar to the results in our study, as the percentage of patients who smoked in our study was 66%, compared to 34% for non-smokers. Importantly, the incidence of PAD increases dramatically with age, doubling with each advancing decade of life - affecting 1 in 10 adults aged 70 years or older. 12 This was confirmed by the results in our study where the largest proportion of patients were aged 60–90 years, accounting for 65% of all patients in the sample. Interventional intravascular procedures is being adopted by a wide range of specialists, including cardiologists trained in vascular interventions, interventional radiologists, and vascular surgeons trained in vascular techniques. A key factor in the successful implementation of interventional intravascular procedures. is the ability to select patients who are likely to benefit from medical treatment. 13 Revascularisation using interventional procedures is usually considered in patients with PAD who have developed any 1 of 3 distinct clinical symptoms: lifestyle-limiting claudication that no longer responds to conservative treatment; critical limb ischemia; or acute limb ischemia (ALI). 13 Patient characteristics such as advanced age, coronary artery disease or heart failure, and ongoing tobacco use often influence clinical decision-making and can make surgical revascularisation unfavorable for patients for whom general anesthesia is too risky. Interventional intravascular revascularisation offers multiple distinct advantages over surgical procedures. These include the use of local anesthesia instead of general anesthesia, shorter hospitalization, and reduced short-term morbidity and mortality. 14 In our study, the most common duration of hospitalization was only one day, and it did not exceed four days except for a small percentage of patients, which amounted to only 3%. The same applies to complications resulting from interventional procedures, which were found in a small percentage of patients, which amounted to only 15%. The anatomic location may help determine the preferred revascularisation strategy, but in general, in patients with aortoiliac stenosis, balloon and stent placement compares favorably with surgical success rates while significantly reducing the risk of periprocedural mortality. Revascularisation of the tibiofibular arteries, or the arteries below the knee, is usually performed by interventional intravascular producers in patients with limb-threatening ischaemia. 15 The Kissing technique has been used to treat peripheral ischemia, which includes balloon angioplasty and stenting. 16 Björses et al. reported that aorto-iliac Kissing stents were an alternative treatment to conventional surgery. 17 This technique was used by 15% in our study. After interventional intravascular production, blood pressure treatment, statin therapy to control lipid levels, smoking cessation and regular exercise are important secondary preventive measures to help minimize future cardiovascular risk. Lifelong monotherapy with low-dose aspirin is usually used after all vascular procedures. Aspirin is warranted to reduce overall cardiovascular events and may help prevent thrombosis at the site of peripheral intervention. 18 These recommendations were similar to the findings in our study, where triple therapy including aspirin, clopidogrel, and statin was the most commonly prescribed treatment for patients after interventional procedures (74%). Although it’s rare, interventional procedures on peripheral vessels can lead to serious complications, the most common of which are pseudoaneurysms, hematomas, arteriovenous fistula, arterial dissection, and local stenosis or occlusion of the stent. Consequences include prolonged hospitalization, increased patient morbidity and mortality, and higher treatment costs. 15% of patients in our study experienced some form of these complications, the most common of which was stent occlusion, which occurred in 7% of patients. References Zemaitis MR, Boll JM, Dreyer MA. Peripheral Arterial Disease. 2023 May 23. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 28613496. Vartanian SM, Conte MS. Surgical intervention for peripheral arterial disease. Circ Res. 2015 Apr 24;116(9):1614-28. doi: 10.1161/CIRCRESAHA.116.303504. PMID: 25908732. Sidawy, Anton N., and Bruce A. Perler., Technique, Rutherford's Vascular Surgery and Endovascular Therapy , 2-Volume Set, E-Book. Elsevier Health Sciences, 2022. ‏ 694-837. Shu, J. and G. Santulli, Update on peripheral artery disease: Epidemiology and evidence-based facts. Atherosclerosis, 2018. 275: p. 379-381. Kokkinidis, D.G. and E.J. Armstrong, Emerging and Future Therapeutic Options for Femoropopliteal and Infrapopliteal Endovascular Intervention. Interv Cardiol Clin, 2017. 6(2): p. 279-295. Varu, V.N., M.E. Hogg, and M.R. Kibbe, Critical limb ischemia. J Vasc Surg, 2010. 51(1): p. 230-41. Novo, S., G. Coppola, and G. Milio, Critical limb ischemia: definition and natural history. Curr Drug Targets Cardiovasc Haematol Disord, 2004. 4(3): p. 219-25. Pabon, M., et al., Sex Differences in Peripheral Artery Disease. Circulation Research, 2022. 130(4): p. 496-511. Kuller, L.H., et al., Incident coronary artery calcium among postmenopausal women. Atherosclerosis, 2008. 200(2): p. 278-85. Daviglus, M.L., et al., Favorable cardiovascular risk profile in young women and long-term risk of cardiovascular and all-cause mortality. Jama, 2004. 292(13): p. 1588-92. Willigendael, E.M., et al., Influence of smoking on incidence and prevalence of peripheral arterial disease. J Vasc Surg, 2004. 40(6): p. 1158-65. Doraiswamy, V.A., J. Giri, and E. Mohler, 3rd, Premature peripheral arterial disease - difficult diagnosis in very early presentation. Int J Angiol, 2009. 18(1): p. 45-7. Thukkani, A.K. and S. Kinlay, Endovascular intervention for peripheral artery disease. Circ Res, 2015. 116(9): p. 1599-613. Lichtenfels, E., et al., Tratamento híbrido para revascularização de membro inferior em paciente com infecção de prótese vascular: relato de caso. Jornal Vascular Brasileiro, 2022. 21. Jones, W.S., et al., AHRQ Comparative Effectiveness Reviews, in Treatment Strategies for Patients With Peripheral Artery Disease. 2013, Agency for Healthcare Research and Quality (US): Rockville (MD). Velasquez, G., et al., Nonsurgical aortoplasty in Leriche syndrome. Radiology, 1980. 134(2): p. 359-360. Björses, K., et al., Kissingstents in the aortic bifurcation–a valid reconstruction for aorto-iliac occlusive disease. European Journal of Vascular and Endovascular Surgery, 2008. 36(4): p. 424-431. Saha, S.P., T.F. Whayne, Jr., and D. Mukherjee, Current evidence for antithrombotic therapy after peripheral vascular interventions. Curr Vasc Pharmacol, 2013. 11(4): p. 507-13. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3985488","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":274680475,"identity":"2a2ae5d0-6678-47c6-8a0c-beebe3c78caa","order_by":0,"name":"Lilas Alhamad","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYBACPmbmBgbGBhAzsfHhhwogDRLBB9iYGWFakpuNJc6AtDAS0MIA15LeJsHbBmIQ0sLO2Pjx5w67aP72xAYJyXm1QAZQy4+Kbfgc1izNeyY5d8aZhw0GhduO5844zNjA2HPmNl6/SDO2Mec23EhsSJDcdiy3AaiFmbENr5bmnz/b6nPnA7Uc4J1zLHc+EVpAvj6cu+FGYmMDb0NN7gZitFjzth3P3XjmYTOzxLEDuRuBWg7i8ws//+HDN3+2VefOO57+/OeHmrrceecPH3zwowK3FnRwGEweIFo9ENSRongUjIJRMApGCAAAI89gaQUsyzEAAAAASUVORK5CYII=","orcid":"","institution":"Faculty of Medicine, Syrian Private University, Damascus, Syria.","correspondingAuthor":true,"prefix":"","firstName":"Lilas","middleName":"","lastName":"Alhamad","suffix":""},{"id":274680520,"identity":"b9ee1530-fc06-4c60-86bf-abeba246bf07","order_by":1,"name":"Muhammad Assem Kubtan","email":"","orcid":"","institution":"Department of Surgery, Medical Faculty, Syrian Private University, Damascus, Syria","correspondingAuthor":false,"prefix":"","firstName":"Muhammad","middleName":"Assem","lastName":"Kubtan","suffix":""}],"badges":[],"createdAt":"2024-02-24 16:08:16","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-3985488/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3985488/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":51684182,"identity":"f744e260-b6a4-4435-926e-ccb8bba6c147","added_by":"auto","created_at":"2024-02-27 07:45:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":177232,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3985488/v1/1df4c2ee-a73c-40f6-a006-a7885b8fa07d.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eThe role of surgical intervention in the treatment of Peripheral Arterial Disease.\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePeripheral arterial disease (PAD) is defined as a decrease in arterial perfusion due to stenosis or occlusion in the vessels, especially in the lower limb. The main cause is usually due to the presence of atheroma.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe clinical manifestations of PAD are categorized into three classifications: Asymptomatic, intermittent claudication, and critical limb ischemia.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Therefore, management depends on the condition of the disease and the severity of symptoms, as treatment options include: Lifestyle changes, pharmacological therapy, interventional intravascular procedures and traditional open surgery.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe gold standard for the management of PAD is by traditional open surgery, but with the new advancement in interventional intravascular procedures treatment, using Vascular Catheterization has become the new unconventional recommended procedure. Which reduces the complications of open surgery and duration of hospitalization. Also, in the future, it is expected to have a positive role in reducing morbidity and mortality.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e"},{"header":"Methods and Materials","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy design:\u003c/h2\u003e\n \u003cp\u003eA retrospective cross-sectional study was conducted to accentuate the role of interventional intravascular procedures on PAD patients who were hospitalized in Damascus Hospital during the period 14-1-2015 to 5-9-2023.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003ePatients:\u003c/h2\u003e\n \u003cp\u003eThe study included 500 patients diagnosed with PAD who were admitted to Damascus Hospital.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eMethods:\u003c/h2\u003e\n \u003cp\u003eThe patient\u0026rsquo;s record was used to fill out a questionnaire by the following criteria.\u003c/p\u003e\n \u003cp\u003eInclusion criteria: all PAD patients who undergo interventional intravascular procedures.\u003c/p\u003e\n \u003cp\u003eExclusion criteria: cases with damaged patient records or with incomplete data, cases in which interventional intravascular procedure was preformed on central arteries and cases only managed by digital subtraction angiography were excluded from the study.\u003c/p\u003e\n \u003cp\u003edata were extracted based on the questionnaire design which included: demographic data, initial clinical presentation, diagnosis, patient history, type of intravascular procedure, medication, duration of hospitalization and patient complications.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003estatistical analysis:\u003c/h2\u003e\n \u003cp\u003eThe collected data from the questionnaire were filled into an Excel file and statistical data analysis was performed using Package for the Social Sciences Statistical (SPSS) version 25. Furthermore, we considered a predictive value of less than 0.05 (p values\u0026thinsp;\u0026lt;\u0026thinsp;0.05) as a statistically significant value.\u003c/p\u003e\n \u003cp\u003eDescriptive statistics were represented by studying the distribution of the sample according to the study variables along with the measures of central tendency (arithmetic mean and standard deviation). We used the Chi-square test to test statistically the relationships between basic characteristics by comparing the categorical variables with normal distribution.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003eEthical consideration:\u003c/h2\u003e\n \u003cp\u003eEthical approval was obtained from the Institutional Review Board (IRB) Faculty of Medicine, Syrian Private University.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe study included 500 patients with the peripheral arterial disease (PAD). 402 of whom were male (80%), while 98 of them were female (20%). Patients ages was ranging from 20\u0026ndash;90 years. There were only 2 patients (0. 4%) in the age group of 20\u0026ndash;30 years, while there were 9 patients ( 2%) in the 30\u0026ndash;40 age group. 50 patients (10%) were in the age group between 40\u0026ndash;50 years. There were 115 patients ( 23%) aged 50\u0026ndash;60. The largest number of patients, amounting to 194 patients, were in the age group of 60\u0026ndash;70 years representing 39%. As for patients in the age group of 70\u0026ndash;80 years, there were 119 patients (24%). Finally, there were 11 patients ( 2%) in the 80\u0026ndash;90 age group.\u003c/p\u003e \u003cp\u003eAmong these patients, there were 285 smokers ( 57% ) and 44 former smokers (9%). The non-smoker patients were 171 ( 34%). As for alcohol consumption, there were only 10 patients ( 2%) who consumed alcohol, while 3 patients (1%) were occasional alcohol consumers. The rest of the patients did not consume alcohol, totaling 489 patients, representing 97%.\u003c/p\u003e \u003cp\u003eAs for the main complaint, 9 patients had pallor (1%), while sensory disturbances occurred in 26 patients ( 2%). Discoloration was observed in 88 patients ( 6%). The non-healing ulcers were reported by 124 patients ( 8%). Cold extremities, numbness and paresthesia were common complaints in 191 and 252 patients at rates of 12% and 16%, respectively. Additionally, 415 patients ( 26%) suffered from intermittent claudication. The most common complaint among the patients was pain, reported by 479 patients, representing 30%.\u003c/p\u003e \u003cp\u003e96 of the patients (19%) were diagnosed with ischemia of both lower limbs. While 201 of the patients (40%) had left lower limb ischemia. Finally, 203 patients (41%) had right lower limb ischemia.\u003c/p\u003e \u003cp\u003eReferring to the history of the sample patients, we found that 16 and 17 patients had heart failure and kidney failure by 2% each. 22 patients ( 3%) had ischemic heart disease. 42 patients ( 5%) had a cerebral vascular accident. 277 patients (34%) had arterial hypertension. Most of patients had diabetes, totaling 369 patients, representing 45%. In contrast, 83 patients had no medical history representing 10%.\u003c/p\u003e \u003cp\u003eFor medication history, 6 patients took proton pump inhibitors and alpha-blockers at a rate of 1% for each, while 19 and 20 patients took antibiotics and vitamins at a rate of 2% for each. Beta-blockers were consumed by 25 patients (3%). As for 42 patients( 5%), diuretics were part of their medication history. 65 patients (7%) were taking pentoxifylline. Additionally, 118 patients were on triple therapy (aspirin, clopidogrel, atorvastatin) at a rate of 13%, while 127 and 186 patients were taking cardiovascular drugs and platelet antiaggregants at rates of 14% and 20% respectively. Finally, most patients, totaling 299, were taking lipid-lowering agents representing 33%.\u003c/p\u003e \u003cp\u003eUpon reviewing the family history of the patients, 5 patients (1%) had a mother who had diabetes, while only one patient (1%) had a sister who had diabetes. For the rest of the 494 patients (99%) in the sample, they did not have family history of diabetes.\u003c/p\u003e \u003cp\u003eRegarding allergic history, penicillin allergy was found in 4 patients (1%), while there were no other allergic histories in the rest of the 496 patients (99%). In terms of surgical history of patients, two patients underwent hernia repair and hemodialysis catheterization, each at a rate of 0.4%, while 8 patients (1%) underwent hernia repair. Additionally, 17 patients underwent gallbladder removal, angiography, and lower limb amputation each at a rate of 3%, while 24 patients (4%) underwent appendectomy. Furthermore, 41 patients (7%) underwent peripheral artery widening. 54 patients ( 10%) underwent coronary artery bypass grafting (CABG). 63 patients ( 11%) underwent percutaneous coronary intervention. The remaining patients, totaling 251, did not undergo any surgical procedure at a rate of 45%.\u003c/p\u003e \u003cp\u003eDrug therapy with stenting was one of the interventional procedures performed on 3 patients (1%), while the kissing procedure was done on 79 patients (15%). Balloon angioplasty was performed on 158 patients (30%). A combination of balloon angioplasty and stenting was carried out on 285 patients (54%).\u003c/p\u003e \u003cp\u003eOnly 2 patients were intervened in the internal iliac artery and the deep femoral artery, each in at a rate of 0.2%. Intervention on the common femoral artery was done in 8 patients (1%). Intervention on the tibiofibular trunk in 11 patients (2%). The intervention on the external iliac artery occurred in 49 patients ( 7%), and on the popliteal artery in 54 patients ( 7%). For 69 patients ( 9%), the intervention occurred on the posterior tibial artery, and the intervention occurred on the two common iliac arteries on both sides, in 79 patients (11%). The anterior peroneal and common iliac arteries were among the arteries that were intervened in 80 and 89 patients, at a rate of 11% and 12%, respectively. The anterior tibial artery was also intervened in 114 patients (16%). Finally, the superficial femoral artery was the most frequently interfered with in 171 patients (23%).\u003c/p\u003e \u003cp\u003eUpon reviewing the medications that the patient was followed up on after the interventional intravascular procedure, Apixaban was prescribed for only one patient (0.2%). Meanwhile, proton pump inhibitors and triple therapy (aspirin with clopidogrel and atorvastatin) were prescribed for 14 patients each at a rate of 3% for each. Enoxaparin was prescribed post-surgery for 16 patients (3%). Glycans therapy was prescribed for 26 patients (5%), while triple therapy with antibiotics and analgesics was prescribed for 89 patients (18%). The majority of patients, totaling 372 patients, were put on triple therapy after surgery at a rate of 74%.\u003c/p\u003e \u003cp\u003eThe majority of patients, 410 out of 500, stayed in the hospital for only one day, accounting for 82%. Whereas, 34 patients (7%) stayed for two days. Additionally, 21 patients (4%) remained for three days. As for the remaining patients, totaling 35, their hospitalization lasted four days or more, comprising 7%.\u003c/p\u003e \u003cp\u003eThe outcome of these surgical interventions and therapeutic procedures was death in 8 patients (2%), while 58 patients (12%) showed improvement with the development of some complications. The rest of the patients, totaling 434, improved, representing 87%.\u003c/p\u003e \u003cp\u003ePostoperative complications resulting from interventional intravascular procedures included stent leakage and the development of a hematoma in only one patient (0.2%). Arterial dissection occurred in two patients (0.3%). 3 patients had pseudoaneurysm developed, also 5 patients experienced infections and emboli with a rate of 1% each. Atrial fibrillation occurred in 7 patients (1%). 8 patients suffered from bleeding and 9 experienced acute kidney failure with a rate of 2% each for both complications. The most common complication among patients was stent occlusion, with 35 patients experiencing this complication at a rate of 7%.\u003c/p\u003e \u003cp\u003eBy studying the relationship between the type of interventional procedure and its outcome on the patient, we did not find a statistically significant relationship. The results were similar among patients. Of the patients who underwent the Kissing procedure, 15% showed improvement, while complications occurred in 13%, and 25% passed away. The P value of 0.770 indicates no significant correlation between these two variables. Similarly, for the rest of the interventional procedures, the proportions of patients in all interventions were similar and the P value\u0026thinsp;\u0026gt;\u0026thinsp;0.05 indicating no strong statistical relationship between the outcome of the interventional procedure and its type on the patient.\u003c/p\u003e \u003cp\u003eIn studying the relationship between interventional procedures and duration of hospitalization, we did not find statistically significant relationships between these variables. For example, in the case of balloon angioplasty, the percentages of the duration of hospitalization were similar, resulting in a P value of 0.860, indicating a lack of a strong significant relationship between these two variables.\u003c/p\u003e \u003cp\u003eSimilarly, for the rest of the interventional procedures and their impact on the duration of hospitalization, the percentages were similar, resulting in P values\u0026thinsp;\u0026gt;\u0026thinsp;0.05, indicating a lack of statistically significant relationships between these variables.\u003c/p\u003e \u003cp\u003eBy studying the relationship between interventional procedures and the gender of the patient, we found a strong statistically significant relationship between the gender of the patient and the procedure involving balloon angioplasty. There were 133 males who underwent this procedure representing 28%, while 45 female patients accounting for 46%. The P value reached 0.0074, indicating a significant relationship between these variables.\u003c/p\u003e \u003cp\u003eAs for the rest of the interventional procedures and their relationship with gender, we did not find a significant relationship between them and the gender of the patient. The proportions of both genders undergoing the other three interventional procedures were similar, with a P value\u0026thinsp;\u0026gt;\u0026thinsp;0.05 indicating no strong statistically significant relationship between these variables.\u003c/p\u003e \u003cp\u003eBy examining the relationship between interventional procedures and patients' age, we found a statistically significant relationship between the Kissing procedure and patients' age, where the majority of patients who underwent this procedure were between 30\u0026ndash;40 years old, with a P value of 0.0008, indicating a significant relationship between these two variables. There was also a statistically significant relationship between balloon angioplasty and the age of the patients, with a P value of 0.0008.\u003c/p\u003e \u003cp\u003eAs for the rest of the procedures, we did not find a relationship between them and the age of the patients, as the proportions of these procedures were similar among all ages of the sample, with P values\u0026thinsp;\u0026gt;\u0026thinsp;0.05, indicating that there is no significant relationship between these variables.\u003c/p\u003e"},{"header":"Discussion","content":" \u003cp\u003eThe prevalence of PAD is estimated at approximately 200\u0026nbsp;million.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Claudication is the most common lifestyle-limiting symptom of PAD. A significant portion of patients with PAD develop pain or ulceration at rest and subsequent need for amputation.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eCritical limb ischemia (CLI) is particularly common in diabetic patients and in patients with arterial calcification. It occurs mainly in the infrapopliteal (IP) vessels and less commonly in the femoropopliteal (FP) artery. In contrast, to claudication that occurs Commonly due to lesions in the FP artery.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eMany traditional risk factors such as hyperlipidemia, diabetes, high blood pressure, smoking history, and obesity are strong risk factors for developing PAD in both genders.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eEven though the prevalence of PAD is similar or higher in women than in men, the associations of traditional and nontraditional risk factors with PAD and the clinical manifestations of PAD differ by sex and may contribute to delayed or underdiagnosis in women.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e These results differed from the results in our study, as the percentage of males with PAD was higher than the percentage of females (80% versus 20%). This difference may be due to the increased risk factors in our study among males compared to females, in terms of smoking and aging.\u003c/p\u003e \u003cp\u003eIn contrast, the prevalence of PAD in post-menopausal women increases,\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e and a woman's risk of incidental vascular disease is determined by the risk factors present during the post-menopausal period.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSmoking is the main preventable cause of PAD in women, especially for those under 50 years of age. Also, in general, patients who smoke are at a four-fold increased risk of developing symptoms of PAD compared to non-smokers.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e These results were similar to the results in our study, as the percentage of patients who smoked in our study was 66%, compared to 34% for non-smokers.\u003c/p\u003e \u003cp\u003eImportantly, the incidence of PAD increases dramatically with age, doubling with each advancing decade of life - affecting 1 in 10 adults aged 70 years or older.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e This was confirmed by the results in our study where the largest proportion of patients were aged 60\u0026ndash;90 years, accounting for 65% of all patients in the sample.\u003c/p\u003e \u003cp\u003eInterventional intravascular procedures is being adopted by a wide range of specialists, including cardiologists trained in vascular interventions, interventional radiologists, and vascular surgeons trained in vascular techniques. A key factor in the successful implementation of interventional intravascular procedures. is the ability to select patients who are likely to benefit from medical treatment.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eRevascularisation using interventional procedures is usually considered in patients with PAD who have developed any 1 of 3 distinct clinical symptoms: lifestyle-limiting claudication that no longer responds to conservative treatment; critical limb ischemia; or acute limb ischemia (ALI).\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ePatient characteristics such as advanced age, coronary artery disease or heart failure, and ongoing tobacco use often influence clinical decision-making and can make surgical revascularisation unfavorable for patients for whom general anesthesia is too risky. Interventional intravascular revascularisation offers multiple distinct advantages over surgical procedures. These include the use of local anesthesia instead of general anesthesia, shorter hospitalization, and reduced short-term morbidity and mortality.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn our study, the most common duration of hospitalization was only one day, and it did not exceed four days except for a small percentage of patients, which amounted to only 3%. The same applies to complications resulting from interventional procedures, which were found in a small percentage of patients, which amounted to only 15%.\u003c/p\u003e \u003cp\u003eThe anatomic location may help determine the preferred revascularisation strategy, but in general, in patients with aortoiliac stenosis, balloon and stent placement compares favorably with surgical success rates while significantly reducing the risk of periprocedural mortality. Revascularisation of the tibiofibular arteries, or the arteries below the knee, is usually performed by interventional intravascular producers in patients with limb-threatening ischaemia.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe Kissing technique has been used to treat peripheral ischemia, which includes balloon angioplasty and stenting.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e Bj\u0026ouml;rses et al. reported that aorto-iliac Kissing stents were an alternative treatment to conventional surgery.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e This technique was used by 15% in our study.\u003c/p\u003e \u003cp\u003eAfter interventional intravascular production, blood pressure treatment, statin therapy to control lipid levels, smoking cessation and regular exercise are important secondary preventive measures to help minimize future cardiovascular risk. Lifelong monotherapy with low-dose aspirin is usually used after all vascular procedures. Aspirin is warranted to reduce overall cardiovascular events and may help prevent thrombosis at the site of peripheral intervention.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThese recommendations were similar to the findings in our study, where triple therapy including aspirin, clopidogrel, and statin was the most commonly prescribed treatment for patients after interventional procedures (74%).\u003c/p\u003e \u003cp\u003eAlthough it\u0026rsquo;s rare, interventional procedures on peripheral vessels can lead to serious complications, the most common of which are pseudoaneurysms, hematomas, arteriovenous fistula, arterial dissection, and local stenosis or occlusion of the stent. Consequences include prolonged hospitalization, increased patient morbidity and mortality, and higher treatment costs. 15% of patients in our study experienced some form of these complications, the most common of which was stent occlusion, which occurred in 7% of patients.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eZemaitis MR, Boll JM, Dreyer MA. Peripheral Arterial Disease. 2023 May 23. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan\u0026ndash;. PMID: 28613496.\u003c/li\u003e\n\u003cli\u003eVartanian SM, Conte MS. Surgical intervention for peripheral arterial disease. Circ Res. 2015 Apr 24;116(9):1614-28. doi: 10.1161/CIRCRESAHA.116.303504. PMID: 25908732.\u003c/li\u003e\n\u003cli\u003eSidawy, Anton N., and Bruce A. Perler., Technique, Rutherford\u0026apos;s Vascular Surgery and Endovascular Therapy , 2-Volume Set, E-Book. Elsevier Health Sciences, 2022.\u003cspan dir=\"RTL\"\u003e\u0026rlm;\u003c/span\u003e 694-837.\u003c/li\u003e\n\u003cli\u003eShu, J. and G. Santulli, Update on peripheral artery disease: Epidemiology and evidence-based facts. Atherosclerosis, 2018. 275: p. 379-381.\u003c/li\u003e\n\u003cli\u003eKokkinidis, D.G. and E.J. Armstrong, Emerging and Future Therapeutic Options for Femoropopliteal and Infrapopliteal Endovascular Intervention. Interv Cardiol Clin, 2017. 6(2): p. 279-295.\u003c/li\u003e\n\u003cli\u003eVaru, V.N., M.E. Hogg, and M.R. Kibbe, Critical limb ischemia. J Vasc Surg, 2010. 51(1): p. 230-41.\u003c/li\u003e\n\u003cli\u003eNovo, S., G. Coppola, and G. Milio, Critical limb ischemia: definition and natural history. Curr Drug Targets Cardiovasc Haematol Disord, 2004. 4(3): p. 219-25.\u003c/li\u003e\n\u003cli\u003ePabon, M., et al., Sex Differences in Peripheral Artery Disease. Circulation Research, 2022. 130(4): p. 496-511.\u003c/li\u003e\n\u003cli\u003eKuller, L.H., et al., Incident coronary artery calcium among postmenopausal women. Atherosclerosis, 2008. 200(2): p. 278-85.\u003c/li\u003e\n\u003cli\u003eDaviglus, M.L., et al., Favorable cardiovascular risk profile in young women and long-term risk of cardiovascular and all-cause mortality. Jama, 2004. 292(13): p. 1588-92.\u003c/li\u003e\n\u003cli\u003eWilligendael, E.M., et al., Influence of smoking on incidence and prevalence of peripheral arterial disease. J Vasc Surg, 2004. 40(6): p. 1158-65.\u003c/li\u003e\n\u003cli\u003eDoraiswamy, V.A., J. Giri, and E. Mohler, 3rd, Premature peripheral arterial disease - difficult diagnosis in very early presentation. Int J Angiol, 2009. 18(1): p. 45-7.\u003c/li\u003e\n\u003cli\u003eThukkani, A.K. and S. Kinlay, Endovascular intervention for peripheral artery disease. Circ Res, 2015. 116(9): p. 1599-613.\u003c/li\u003e\n\u003cli\u003eLichtenfels, E., et al., Tratamento h\u0026iacute;brido para revasculariza\u0026ccedil;\u0026atilde;o de membro inferior em paciente com infec\u0026ccedil;\u0026atilde;o de pr\u0026oacute;tese vascular: relato de caso. Jornal Vascular Brasileiro, 2022. 21.\u003c/li\u003e\n\u003cli\u003eJones, W.S., et al., AHRQ Comparative Effectiveness Reviews, in Treatment Strategies for Patients With Peripheral Artery Disease. 2013, Agency for Healthcare Research and Quality (US): Rockville (MD).\u003c/li\u003e\n\u003cli\u003eVelasquez, G., et al., Nonsurgical aortoplasty in Leriche syndrome. Radiology, 1980. 134(2): p. 359-360.\u003c/li\u003e\n\u003cli\u003eBj\u0026ouml;rses, K., et al., Kissingstents in the aortic bifurcation\u0026ndash;a valid reconstruction for aorto-iliac occlusive disease. European Journal of Vascular and Endovascular Surgery, 2008. 36(4): p. 424-431.\u003c/li\u003e\n\u003cli\u003eSaha, S.P., T.F. Whayne, Jr., and D. Mukherjee, Current evidence for antithrombotic therapy after peripheral vascular interventions. Curr Vasc Pharmacol, 2013. 11(4): p. 507-13.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Syrian Private University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Peripheral arterial disease, Interventional vascular procedures, Intermittent Claudication","lastPublishedDoi":"10.21203/rs.3.rs-3985488/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3985488/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eAim and background:\u003c/h2\u003e \u003cp\u003eThe increase of peripheral arterial disease (PAD) to an estimated 200\u0026nbsp;million patients along with its life-limiting symptoms and the complications of treatment with traditional open surgery; builds a need to advance interventional intravascular procedures treatment. This study aims to accentuate the role of interventional intravascular procedures on PAD patients.\u003c/p\u003e\u003ch2\u003eMethods and material:\u003c/h2\u003e \u003cp\u003eA Cross-sectional retrospective study. The study was performed on 500 patients who were admitted at Damascus hospital for interventional intravascular procedure, during the period 14-1-2015 to 5-9-2023. A questionnaire was designed to include demographic data, initial clinical presentation, diagnosis, patient history, type of intravascular procedure, medication, duration of hospitalization and patient complications.\u003c/p\u003e\u003ch2\u003eResult:\u003c/h2\u003e \u003cp\u003eThe majority of patient who are 194 patients were in the age group of 60\u0026ndash;70 years, representing 39%. The male patients were 402 patients, accounting for 80%. The most common complaint among patients was pain representing 30%. 171 (23%) patients had a superficial femoral artery complaint and were the most frequently subjected arteries to interventional procedures.The largest number of patients, 410 patients, spent only one day in the hospital representing 82%. The most common complication among patients was stent occlusion, with 35 patients (7%). There was a strong statistically significant relationship between the gender of the patient and the procedure involving balloon angioplasty and a significant relationship between the Kissing procedure and patients' age.\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eThis study shows the importance of interventional procedures in treating peripheral vascular disease compared to conventional surgery. However, interventional intravascular procedure remains the surgical intervention which has its own complications, and studies on the benefit of the interventional procedure are still insufficient.\u003c/p\u003e","manuscriptTitle":"The role of surgical intervention in the treatment of Peripheral Arterial Disease.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-27 07:45:47","doi":"10.21203/rs.3.rs-3985488/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a9ab8f43-3494-48cf-bd42-b2438ba5c501","owner":[],"postedDate":"February 27th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":28952488,"name":"Surgery"}],"tags":[],"updatedAt":"2024-02-27T07:45:47+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-27 07:45:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3985488","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3985488","identity":"rs-3985488","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}