University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository

Endovascular versus Open Interventions in Reducing Major Amputations in Peripheral Arterial Disease


Vascular Surgery


Dr. Elyse Watkins



Objective: The objective of this review is to assess whether endovascular interventions or open revascularization procedures reduce major amputations in patients with peripheral arterial disease.

Methods: A PubMed literature search was performed using Medical Subjects Headings (MeSH) of peripheral arterial disease, major amputations, open bypass, endovascular, and endovasc*, and the search terms endovascular intervention, bypass, and femoropopliteal. Nine articles were retrieved and used as reference for this clinical review.

Results: Proximal lower extremity amputations are associated with increased perioperative morbidity. Endovascular procedures are less invasive and require shorter hospitalizations. Patients who underwent open revascularization have longer hospitalizations. Patients who underwent open revascularization demonstrated better patency rates. Neither endovascular nor open revascularization is superior in the reduction of major amputations within one year of revascularization. Patients with TASC C or D lesions, a life expectancy of greater than two years, and an adequate autogenous vein for bypass procedure are best served with open revascularization.

Conclusions: A patient’s revascularization treatment plan should be individualized for each patient based on their anatomy, extent of disease, and risk factors to attempt limb salvage.

Keywords: peripheral arterial disease; treatment; endovascular; atherectomy; angioplasty; bypass; open revascularization; amputation

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