PMID- 32431246 OWN - NLM STAT- MEDLINE DCOM- 20201102 LR - 20221207 IS - 1545-1550 (Electronic) IS - 1526-6028 (Linking) VI - 27 IP - 4 DP - 2020 Aug TI - Limb-Based Patency After Surgical vs Endovascular Revascularization in Patients with Chronic Limb-Threatening Ischemia. PG - 584-594 LID - 10.1177/1526602820923388 [doi] AB - PURPOSE: To determine whether limb-based patency (LBP) after infrainguinal revascularization for chronic limb-threatening ischemia (CLTI) is similar between bypass surgery and endovascular therapy (EVT). MATERIALS AND METHODS: The database for the Surgical Reconstruction vs Peripheral Intervention in Patients With Critical Limb Ischemia (SPINACH) study was interrogated to identify 130 patients (mean age 73+/-8 years; 94 men) who underwent bypass surgery and 271 patients (mean age 74+/-10 years; 178 men) who underwent EVT alone. Skin perfusion pressure (SPP) and the ankle-brachial index (ABI) were measured before the procedure and at 0, 1, and 3 months after revascularization. The outcome measure was hemodynamically evaluated LBP (SPP >/=10 mm Hg or ABI >/=0.1) maintained over the first 3 months after treatment. Any reintervention or major amputation was regarded as loss of LBP. The associations between the revascularization strategy (bypass vs EVT) and between the preoperative characteristics and the study outcome (ie, SPP- or ABI-based LBP), were determined using generalized linear mixed models with a logit link function. Patency rates are presented with the 95% confidence interval (CI). RESULTS: The bypass surgery group had a higher stage of limb severity (WIfI) and anatomic complexity (GLASS) than the EVT group, whereas the EVT group had a higher prevalence of heart failure. Both SPP- and ABI-based LBP rates were higher in the bypass group than in the EVT group. SPP-based LBP rates at 3 months were 73.8% (95% CI 63.4% to 84.2%) in the bypass group and 46.2% (95% CI 38.5% to 53.8%) in the EVT group; the corresponding ABI-based LBP rates were 71.5% (95% CI 61.8% to 81.2%) and 44.0% (95% CI 37.3% to 50.7%). CONCLUSION: LBP is an important concept in the new global vascular guidelines for assessing the anatomic and hemodynamic status of CLTI patients. The present study found that LBP was significantly lower in the EVT group vs the bypass surgery group. FAU - Utsunomiya, Makoto AU - Utsunomiya M AUID- ORCID: 0000-0002-4248-1928 AD - Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan. FAU - Takahara, Mitsuyoshi AU - Takahara M AD - Department of Metabolic Medicine and Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan. FAU - Iida, Osamu AU - Iida O AUID- ORCID: 0000-0001-6829-7304 AD - Cardiovascular Division, Kansai Rosai Hospital, Amagasaki, Japan. FAU - Soga, Yoshimitsu AU - Soga Y AUID- ORCID: 0000-0003-1931-5769 AD - Cardiovascular Medicine, Kokura Memorial Hospital, Kitakyushu, Japan. FAU - Hata, Yosuke AU - Hata Y AUID- ORCID: 0000-0001-5482-3502 AD - Cardiovascular Division, Kansai Rosai Hospital, Amagasaki, Japan. FAU - Shiraki, Tatsuya AU - Shiraki T AUID- ORCID: 0000-0003-1901-1642 AD - Cardiovascular Medicine, Osaka University, Osaka, Japan. FAU - Nagae, Ayumu AU - Nagae A AUID- ORCID: 0000-0001-8358-4360 AD - Cardiovascular Medicine, Shinshu University, Nagano, Japan. FAU - Kato, Tamon AU - Kato T AD - Cardiovascular Medicine, Shinshu University, Nagano, Japan. FAU - Kobayashi, Norihiro AU - Kobayashi N AUID- ORCID: 0000-0003-1254-0621 AD - Cardiovascular Medicine, Saiseikai Yokohama Tobu Hospital, Yokohama, Japan. FAU - Suematsu, Nobuhiro AU - Suematsu N AD - Cardiovascular Medicine, Saiseikai Fukuoka General Hospital, Fukuoka, Japan. FAU - Tasaki, Junichi AU - Tasaki J AD - Cardiovascular Medicine, Kyoto University, Kyoto, Japan. FAU - Horie, Kazunori AU - Horie K AUID- ORCID: 0000-0002-8614-7729 AD - Cardiovascular Medicine, Sendai Kosei Hospital, Sendai, Japan. FAU - Uchida, Daiki AU - Uchida D AD - Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan. FAU - Kodama, Akio AU - Kodama A AD - Division of Vascular Surgery, Nagoya University School of Medicine, Nagoya, Japan. FAU - Azuma, Nobuyoshi AU - Azuma N AD - Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan. FAU - Nakamura, Masato AU - Nakamura M AD - Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan. LA - eng PT - Journal Article PT - Multicenter Study PT - Observational Study DEP - 20200520 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):595-598. PMID: 32495681 MH - Aged MH - Aged, 80 and over MH - Amputation, Surgical MH - Chronic Disease MH - Databases, Factual MH - *Endovascular Procedures/adverse effects MH - Female MH - Humans MH - Ischemia/diagnostic imaging/physiopathology/*therapy MH - Japan MH - Limb Salvage MH - Male MH - Middle Aged MH - Peripheral Arterial Disease/diagnostic imaging/physiopathology/*therapy MH - Registries MH - Retrospective Studies MH - Risk Factors MH - Time Factors MH - Treatment Outcome MH - *Vascular Patency MH - *Vascular Surgical Procedures/adverse effects OTO - NOTNLM OT - ankle-brachial index OT - bypass graft OT - bypass surgery OT - chronic limb-threatening ischemia OT - critical limb ischemia, endovascular therapy OT - infrainguinal bypass OT - limb-based patency OT - skin perfusion pressure EDAT- 2020/05/21 06:00 MHDA- 2020/11/03 06:00 CRDT- 2020/05/21 06:00 PHST- 2020/05/21 06:00 [pubmed] PHST- 2020/11/03 06:00 [medline] PHST- 2020/05/21 06:00 [entrez] AID - 10.1177/1526602820923388 [doi] PST - ppublish SO - J Endovasc Ther. 2020 Aug;27(4):584-594. doi: 10.1177/1526602820923388. Epub 2020 May 20.