PMID- 32419595
OWN - NLM
STAT- MEDLINE
DCOM- 20201102
LR  - 20221207
IS  - 1545-1550 (Electronic)
IS  - 1526-6028 (Linking)
VI  - 27
IP  - 4
DP  - 2020 Aug
TI  - A Global Vascular Guidelines-Based Bypass-Preferred Population and Their Surgical 
      Risk Among CLTI Patients Treated With Endovascular Therapy in a Real-World 
      Practice.
PG  - 608-613
LID - 10.1177/1526602820924338 [doi]
AB  - PURPOSE: To determine in a chronic limb-threatening ischemia (CLTI) population 
      who underwent endovascular therapy (EVT) how many patients would have been 
      categorized as preferred for bypass surgery according to the Global Vascular 
      Guidelines (GVG) and ascertain their surgical risk. MATERIALS AND METHODS: The 
      current study analyzed 1043 CLTI patients who presented WIfI (wound, ischemia, 
      and foot infection) stage >/=2 and underwent EVT between April 2010 and December 
      2017. Of these, 176 were excluded for lack of angiographic or other data, leaving 
      867 CLTI patients (mean age 74+/-10 years; 523 men) for stratification according to 
      the GVG into bypass-preferred, indeterminate, or EVT-preferred groups. The GVG 
      recommend bypass as the first-line treatment when the wound is severe (WIfI stage 
      >/=3) and lesions are complex (GLASS stage III). Surgical risk was estimated using 
      the modified PREVENT III risk score. To further stratify the bypass-preferred 
      population according to mortality risk, a survival decision tree was constructed 
      using recursive partitioning. RESULTS: The bypass-preferred group accounted for 
      55% [95% confidence interval (CI) 51% to 58%] of the overall population. The 
      decision tree analysis extracted a low-mortality risk subgroup with a survival 
      rate of 99% (95% CI 98% to 100%) at 1 month and 80% (95% CI 73% to 87%) at 2 
      years. According to the PREVENT III score, 34% (95% CI 27% to 42%) of the low 
      mortality risk subgroup were classified as high surgical risk. CONCLUSION: A high 
      proportion of patients undergoing EVT were considered bypass preferred based on 
      the GVG, and the survival of these patients was not significantly different 
      whether they were high or low surgical risk.
FAU - Okamoto, Shin
AU  - Okamoto S
AUID- ORCID: 0000-0002-9178-5514
AD  - Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
FAU - Iida, Osamu
AU  - Iida O
AUID- ORCID: 0000-0001-6829-7304
AD  - Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
FAU - Takahara, Mitsuyoshi
AU  - Takahara M
AD  - Department of Diabetes Care Medicine, Osaka University Graduate School of 
      Medicine, Suita, Japan.
FAU - Hata, Yosuke
AU  - Hata Y
AUID- ORCID: 0000-0001-5482-3502
AD  - Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
FAU - Asai, Mitsutoshi
AU  - Asai M
AD  - Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
FAU - Masuda, Masaharu
AU  - Masuda M
AD  - Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
FAU - Ishihara, Takayuki
AU  - Ishihara T
AD  - Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
FAU - Nanto, Kiyonori
AU  - Nanto K
AD  - Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
FAU - Kanda, Takashi
AU  - Kanda T
AD  - Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
FAU - Tsujimura, Takuya
AU  - Tsujimura T
AUID- ORCID: 0000-0002-3128-1357
AD  - Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
FAU - Okuno, Syota
AU  - Okuno S
AD  - Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
FAU - Matsuda, Yasuhiro
AU  - Matsuda Y
AD  - Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
FAU - Mano, Toshiaki
AU  - Mano T
AD  - Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
LA  - eng
PT  - Journal Article
DEP - 20200518
PL  - United States
TA  - J Endovasc Ther
JT  - Journal of endovascular therapy : an official journal of the International 
      Society of Endovascular Specialists
JID - 100896915
SB  - IM
CIN - J Endovasc Ther. 2020 Aug;27(4):614-615. PMID: 32495685
MH  - Aged
MH  - Aged, 80 and over
MH  - Amputation, Surgical/standards
MH  - Chronic Disease
MH  - *Clinical Decision-Making
MH  - Endovascular Procedures/adverse effects/mortality/*standards
MH  - Female
MH  - Guideline Adherence/standards
MH  - Humans
MH  - Ischemia/diagnosis/mortality/*therapy
MH  - Limb Salvage/standards
MH  - Male
MH  - Middle Aged
MH  - *Patient Selection
MH  - Peripheral Arterial Disease/diagnosis/mortality/*therapy
MH  - Practice Guidelines as Topic/*standards
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
MH  - Vascular Grafting/adverse effects/mortality/*standards
OTO - NOTNLM
OT  - Bypass surgery
OT  - Global Vascular Guidelines
OT  - chronic limb-threatening ischemia
OT  - endovascular therapy
OT  - mortality risk
OT  - peripheral artery disease
OT  - surgical risk
OT  - survival
EDAT- 2020/05/19 06:00
MHDA- 2020/11/03 06:00
CRDT- 2020/05/19 06:00
PHST- 2020/05/19 06:00 [pubmed]
PHST- 2020/11/03 06:00 [medline]
PHST- 2020/05/19 06:00 [entrez]
AID - 10.1177/1526602820924338 [doi]
PST - ppublish
SO  - J Endovasc Ther. 2020 Aug;27(4):608-613. doi: 10.1177/1526602820924338. Epub 2020 
      May 18.