PMID- 32276010 OWN - NLM STAT- MEDLINE DCOM- 20210315 LR - 20221207 IS - 1097-6809 (Electronic) IS - 0741-5214 (Linking) VI - 72 IP - 6 DP - 2020 Dec TI - Amputation-free survival, limb symptom alleviation, and reintervention rates after open and endovascular revascularization of femoropopliteal lesions in patients with chronic limb-threatening ischemia. PG - 1987-1995 LID - S0741-5214(20)30483-3 [pii] LID - 10.1016/j.jvs.2020.03.029 [doi] AB - BACKGROUND: The optimal strategy for revascularization in chronic limb-threatening ischemia (CLTI) is not yet completely known and is still under debate. Endovascular treatment methods predominate despite limited evidence for their advantage. In this concurrent, prospective observational cohort study, we investigated outcomes after open and endovascular revascularization in the femoropopliteal segment for CLTI. METHODS: Between March 2011 and January 2015, there were 190 patients presenting with CLTI with the principal target lesion in the superficial femoral or popliteal segment who underwent endovascular intervention (n = 117) or bypass surgery (n = 73) and were observed prospectively. The choice of revascularization technique was based on international and local guidelines. All patients were observed for 2 years. The primary end point was amputation-free survival (AFS) assessed with Kaplan-Meier estimates; secondary end points included CLTI symptom alleviation rates and reintervention rates. A Cox proportional hazards regression model was used to investigate risk factors for amputation and death. RESULTS: AFS at 2 years was 59% in the endovascular group and 76% in the bypass group (P = .020). Kaplan-Meier survival analysis confirmed a significant difference in AFS, with mortality rate as the main driver for the observed intergroup AFS difference. In sequential multivariable regression analysis, the observed difference in AFS between the groups favored bypass surgery and remained significant after controlling for covariates of known prognostic importance (hazard ratio, 2.38; 95% confidence interval, 1.14-4.96). At 2 years, a higher proportion of patients subjected to bypass surgery remained free from ischemic rest pain, wounds, and gangrene (65% vs 45%; P = .009). The proportions of patients who underwent reintervention within 2 years were similar in the two groups (38% vs 39%; P = .90), but repeated reinterventions were more frequent in the bypass group. CONCLUSIONS: At 2 years, bypass surgery was associated with higher AFS than endovascular intervention, a finding that could not be explained only by differences in case mix. More patients who had bypass surgery were free from CLTI symptoms at both 1 year and 2 years after revascularization. Reinterventions to maintain patency were equally common after bypass and endovascular intervention. CI - Copyright (c) 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved. FAU - Perlander, Angelica AU - Perlander A AD - Department of Vascular Surgery, Sahlgrenska University Hospital, and Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Electronic address: angelica.perlander@vgregion.se. FAU - Jivegard, Lennart AU - Jivegard L AD - Health Technology Assessment Centre (HTA-centrum) Region Vastra Gotaland, Sahlgrenska University Hospital, Gothenburg, Sweden. FAU - Nordanstig, Joakim AU - Nordanstig J AD - Department of Vascular Surgery, Sahlgrenska University Hospital, and Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. FAU - Svensson, Mikael AU - Svensson M AD - School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden. FAU - Osterberg, Klas AU - Osterberg K AD - Department of Vascular Surgery, Sahlgrenska University Hospital, and Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. LA - eng PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Observational Study PT - Research Support, Non-U.S. Gov't DEP - 20200408 PL - United States TA - J Vasc Surg JT - Journal of vascular surgery JID - 8407742 SB - IM MH - Aged MH - Aged, 80 and over MH - *Amputation, Surgical/adverse effects/mortality MH - Chronic Disease MH - *Endovascular Procedures/adverse effects/mortality MH - Female MH - Femoral Artery/diagnostic imaging/physiopathology/*surgery MH - Humans MH - Ischemia/diagnostic imaging/mortality/physiopathology/*surgery MH - Limb Salvage MH - Male MH - Middle Aged MH - Peripheral Arterial Disease/diagnostic imaging/mortality/physiopathology/*surgery MH - Popliteal Artery/diagnostic imaging/physiopathology/*surgery MH - Progression-Free Survival MH - Prospective Studies MH - Reoperation MH - Risk Assessment MH - Risk Factors MH - Sweden MH - Time Factors MH - *Vascular Grafting/adverse effects/mortality MH - Vascular Patency OTO - NOTNLM OT - Amputation-free survival OT - Bypass surgery OT - Chronic limb-threatening ischemia OT - Critical ischemia OT - Endovascular intervention EDAT- 2020/04/11 06:00 MHDA- 2021/03/16 06:00 CRDT- 2020/04/11 06:00 PHST- 2019/12/20 00:00 [received] PHST- 2020/03/05 00:00 [accepted] PHST- 2020/04/11 06:00 [pubmed] PHST- 2021/03/16 06:00 [medline] PHST- 2020/04/11 06:00 [entrez] AID - S0741-5214(20)30483-3 [pii] AID - 10.1016/j.jvs.2020.03.029 [doi] PST - ppublish SO - J Vasc Surg. 2020 Dec;72(6):1987-1995. doi: 10.1016/j.jvs.2020.03.029. Epub 2020 Apr 8.