PMID- 33819581
OWN - NLM
STAT- MEDLINE
DCOM- 20211231
LR  - 20221207
IS  - 1615-5947 (Electronic)
IS  - 0890-5096 (Linking)
VI  - 75
DP  - 2021 Aug
TI  - A Propensity-Matched Analysis of Endovascular Intervention versus Open 
      Nonautologous Bypass as Initial Therapy in Patients with Chronic Limb-Threatening 
      Ischemia.
PG  - 194-204
LID - S0890-5096(21)00223-5 [pii]
LID - 10.1016/j.avsg.2021.02.024 [doi]
AB  - OBJECTIVES: Endovascular therapies are increasingly used in patients with complex 
      multilevel disease and chronic limb-threatening ischemia (CLTI). Infrageniculate 
      bypass with autologous vein conduit is considered the gold standard in these 
      patients. However, many patients often lack optimal saphenous vein, leading to 
      the use of nonautologous prosthetic conduit. We compared limb salvage and 
      survival rates for patients with CLTI undergoing first time revascularization 
      with either open nonautologous conduit or endovascular intervention. METHODS: We 
      retrospectively reviewed consecutive patients undergoing first time endovascular 
      or open surgical revascularization at our institution between 2009 and 2016. 
      Patients were divided into endovascular intervention or open bypass with 
      nonautologous conduit (NAC) cohorts. Primary endpoints were amputation-free 
      survival (AFS), freedom from reintervention, primary patency, and overall 
      survival. Propensity scoring was used to construct matched cohorts. Outcomes were 
      evaluated using Kaplan-Meier and Cox Proportional Hazards models. RESULTS: A 
      total of 125 revascularizations were identified. There were 65 endovascular 
      interventions and 60 NAC bypasses. In unmatched analysis, there was an elevated 
      risk of perioperative MI (7% vs. 0%, P = 0.05) and amputation (10% vs. 2%, 
      P = 0.04) for the NAC groups compared to the endovascular group. In matched 
      analysis, endovascular patients had a lower incidence of 30-day amputation (1.5% 
      vs. 10% P = 0.04) and length of stay (median days, 1 vs. 9, P < 0.01) compared to 
      the open cohort. While not statistically significant, the endovascular group 
      trended towards increased rates of two-year AFS (76% vs. 65%, P = 0.07) compared 
      to the NAC group. There was no significant difference in overall survival when 
      the endovascular cohort was compared to NAC (85% vs. 77%, P = 0.29) patients. In 
      matched Cox analysis, nonautologous conduit use was associated with an increased 
      risk of limb loss (HR 2.03, 95% CI 0.94-4.38, P = 0.07) compared to endovascular 
      revascularization. CONCLUSIONS: An "endovascular first" approach offers favorable 
      perioperative outcomes and comparable AFS compared to NAC and may be preferable 
      when autologous conduit is unavailable.
CI  - Copyright (c) 2021. Published by Elsevier Inc.
FAU - Futchko, John
AU  - Futchko J
AD  - Department of Vascular Surgery, Montefiore Medical Center, Bronx, New York.
FAU - Friedmann, Patricia
AU  - Friedmann P
AD  - Department of Surgery, Albert Einstein College of Medicine, Bronx, New York.
FAU - Phair, John
AU  - Phair J
AD  - Department of Vascular Surgery, Montefiore Medical Center, Bronx, New York.
FAU - Trestman, Eric B
AU  - Trestman EB
AD  - Department of Vascular Surgery, Montefiore Medical Center, Bronx, New York.
FAU - Denesopolis, John
AU  - Denesopolis J
AD  - Department of Vascular Surgery, Montefiore Medical Center, Bronx, New York.
FAU - Shariff, Saadat
AU  - Shariff S
AD  - Department of Vascular Surgery, Montefiore Medical Center, Bronx, New York.
FAU - Scher, Larry A
AU  - Scher LA
AD  - Department of Vascular Surgery, Montefiore Medical Center, Bronx, New York.
FAU - Lipsitz, Evan C
AU  - Lipsitz EC
AD  - Department of Vascular Surgery, Montefiore Medical Center, Bronx, New York.
FAU - Porreca, Francis
AU  - Porreca F
AD  - Department of Vascular Surgery, Montefiore Medical Center, Bronx, New York.
FAU - Garg, Karan
AU  - Garg K
AD  - Department of Vascular Surgery, Montefiore Medical Center, Bronx, New York. 
      Electronic address: karangarg082@gmail.com.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20210402
PL  - Netherlands
TA  - Ann Vasc Surg
JT  - Annals of vascular surgery
JID - 8703941
SB  - IM
MH  - Aged
MH  - Amputation, Surgical
MH  - Blood Vessel Prosthesis
MH  - *Blood Vessel Prosthesis Implantation/adverse effects/instrumentation/mortality
MH  - Chronic Disease
MH  - Clinical Decision-Making
MH  - *Endovascular Procedures/adverse effects/instrumentation/mortality
MH  - Female
MH  - Humans
MH  - Ischemia/diagnostic imaging/mortality/*surgery
MH  - Limb Salvage
MH  - Male
MH  - Peripheral Arterial Disease/diagnostic imaging/mortality/*surgery
MH  - Propensity Score
MH  - Risk Assessment
MH  - Risk Factors
MH  - Stents
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2021/04/06 06:00
MHDA- 2022/01/01 06:00
CRDT- 2021/04/05 20:10
PHST- 2020/12/02 00:00 [received]
PHST- 2021/02/03 00:00 [revised]
PHST- 2021/02/15 00:00 [accepted]
PHST- 2021/04/06 06:00 [pubmed]
PHST- 2022/01/01 06:00 [medline]
PHST- 2021/04/05 20:10 [entrez]
AID - S0890-5096(21)00223-5 [pii]
AID - 10.1016/j.avsg.2021.02.024 [doi]
PST - ppublish
SO  - Ann Vasc Surg. 2021 Aug;75:194-204. doi: 10.1016/j.avsg.2021.02.024. Epub 2021 
      Apr 2.