In-hospital outcomes of endovascular versus surgical revascularization for chronic total occlusion in peripheral artery disease

Mohamed Zghouzi, Homam Moussa Pacha, Waqas Ullah, Yasar Sattar, Bachar Ahmad, Heba Osman, Mohamed O. Mohamed, Tanveer Mir, Subhash Banerjee, Mehdi H. Shishehbor, Anand Prasad, Yevgeniy Rits, Mamas A. Mamas, M. Chadi Alraies

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background: The outcome of endovascular intervention (EVI) compared vs. surgical revascularization in patients with peripheral artery disease (PAD) due to chronic total occlusion (CTO) is unknown. Methods: Using the National Inpatient Sample database between 2007 and 2014, we identified all PAD patients with CTO who had limb revascularization. Multivariate analysis was performed to estimate the odds of in-hospital mortality and adverse outcomes between both groups. Results: A total of 168,420 patients who had peripheral CTO and underwent limb revascularization were identified. 99,279 underwent EVI, and 69,141 underwent surgical revascularization. The patients who underwent EVI were younger, more likely to be women and African American, and less likely to be white (p < 0.001 for all). EVI was associated with lower in-hospital mortality (1.2% vs 1.7%, adjusted odds ratio [aOR]: 0.54; 95% confidence interval [CI] 0.50–0.59). The EVI group had higher vascular complications, major bleeding, acute kidney injury (AKI), and major amputation compared with surgical revascularization. A subgroup analysis on patients with critical limb ischemia showed lower mortality in the EVI group (1.4% vs. 1.9, aOR 0.56; 95% CI 0.50–0.63). Although there was no difference in the incidence of AKI or major amputation between the two groups, the EVI group had higher vascular complication rates and major bleeding events. Conclusion: EVI in PAD with CTO is associated with lower in-hospital mortality, likely due to the procedure's less-invasive nature; however, it is associated with higher postprocedural complications likely due to the CTO's complexity.

Original languageEnglish (US)
Pages (from-to)E586-E593
JournalCatheterization and Cardiovascular Interventions
Issue number4
StatePublished - Oct 2021


  • bypass surgery
  • chronic total occlusion
  • endovascular intervention
  • peripheral arterial disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging


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