Comparative Outcomes of Endovascular and Open Revascularization in Peripheral Arterial Disease: A Prospective Cohort Study

Abstract

Background: Peripheral arterial disease (PAD) represents a major global health burden associated with significant morbidity, impaired functional status, and risk of limb loss. While endovascular techniques have evolved rapidly and are increasingly adopted as first-line therapy, uncertainty remains regarding comparative clinical outcomes relative to traditional open surgical revascularization. This prospective study aimed to evaluate short- and intermediate-term outcomes following endovascular versus open revascularization in patients with symptomatic PAD in a real-world clinical setting.

Methods: In this prospective observational cohort study, consecutive adult patients with symptomatic PAD (Rutherford categories 3–6) undergoing planned revascularization at a tertiary care center were enrolled between [Month Year–Month Year]. Treatment allocation was determined by multidisciplinary clinical decision-making. Patients were categorized into endovascular and open surgical groups. The primary endpoint was limb salvage at 6 months. Secondary endpoints included procedural success, improvement in ankle–brachial index (ABI), perioperative complications, reintervention rates, length of hospital stay, and mortality. Outcomes were compared using appropriate statistical tests, and multivariable regression analysis was performed to adjust for baseline confounders.

Results: A total of 120 patients were included, comprising 68 endovascular and 52 open surgical procedures. Mean age was 61.3 ± 9.4 years, and 61.7% were male; diabetes mellitus was present in 68.3%. Limb salvage at 6 months was comparable between groups (89.7% vs 86.5%, p = 0.58). Both cohorts demonstrated significant improvement in ABI, without intergroup difference (mean increase 0.32 ± 0.11 vs 0.35 ± 0.14; p = 0.21). The endovascular group showed lower overall complication rates (11.8% vs 23.1%, p = 0.04) and shorter hospital stay (3.6 ± 1.2 vs 8.4 ± 2.6 days, p < 0.001). Reintervention rates and short-term mortality were similar between groups.

Conclusions: Endovascular revascularization achieved limb salvage outcomes comparable to open surgical approaches while offering reduced perioperative morbidity and shorter hospitalization. These findings support a contemporary endovascular-first strategy in appropriately selected patients with PAD, highlighting the need for individualized treatment planning based on anatomical complexity and patient risk profile.