PMID- 35934216
OWN - NLM
STAT- MEDLINE
DCOM- 20221226
LR  - 20230202
IS  - 1097-6809 (Electronic)
IS  - 0741-5214 (Linking)
VI  - 77
IP  - 1
DP  - 2023 Jan
TI  - Outcomes of a bypass-first strategy in chronic limb-threatening ischemia based on 
      the Global Vascular Guidelines.
PG  - 201-207
LID - S0741-5214(22)01950-4 [pii]
LID - 10.1016/j.jvs.2022.06.103 [doi]
AB  - OBJECTIVE: The Global Vascular Guidelines (GVGs) recommend initial 
      revascularization (bypass or endovascular therapy) for chronic limb-threatening 
      ischemia (CLTI) based on anatomical complexity and limb severity. This decision 
      is made based on a prediction of the outcomes after endovascular intervention. 
      This study was performed to evaluate outcomes after distal bypass in cases 
      recommended for GVG bypass. METHODS: A total of 239 distal bypasses for CLTI were 
      evaluated in 195 patients with a GVG bypass recommendation treated between 2009 
      and 2020 at a single center in Japan. Comparisons were made between crural and 
      pedal bypass cases. RESULTS: The 195 patients (median age, 77 years; 67% male) 
      underwent 133 crural bypasses (106 patients; 54%) and 106 pedal bypasses (89 
      patients; 46%). Hemodialysis was more common in pedal cases than in crural cases 
      (P = .03). Hospital deaths occurred in two cases (1%) within 30 days. The whole 
      cohort has a follow-up rate of 96% over a mean of 28 +/- 26 months, with 3-year 
      limb salvage rates of 87% and 3-year primary, assisted primary, and secondary 
      patency rates of 40%, 65%, and 67%, all without significant differences between 
      crural and pedal cases. The 1-year wound healing rate was 88% and tended to be 
      higher in crural cases than in pedal cases (P = .068). The 3-year survival rate 
      was 52% in the cohort and did not differ significantly between crural and pedal 
      cases. CONCLUSIONS: Patients with CLTI with a GVG bypass recommendation had 
      acceptable limb salvage, graft patency, wound healing, and survival after distal 
      bypass, regardless of the bypass method. These findings indicate that a GVG 
      bypass recommendation as an initial revascularization method is valid in the real 
      world.
CI  - Copyright (c) 2022 Society for Vascular Surgery. Published by Elsevier Inc. All 
      rights reserved.
FAU - Kobayashi, Taira
AU  - Kobayashi T
AD  - Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hiroshima, 
      Japan. Electronic address: ja-t-coba@hotmail.co.jp.
FAU - Hamamoto, Masaki
AU  - Hamamoto M
AD  - Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hiroshima, 
      Japan.
FAU - Okazaki, Takanobu
AU  - Okazaki T
AD  - Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hiroshima, 
      Japan.
FAU - Tomota, Mayu
AU  - Tomota M
AD  - Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hiroshima, 
      Japan.
FAU - Fujiwara, Takashi
AU  - Fujiwara T
AD  - Department of Cardiology, JA Hiroshima General Hospital, Hiroshima, Japan.
FAU - Yoshitomi, Yuki
AU  - Yoshitomi Y
AD  - Department of Cardiology, JA Hiroshima General Hospital, Hiroshima, Japan.
FAU - Hasegawa, Misa
AU  - Hasegawa M
AD  - Department of Reconstructive and Plastic Surgery, JA Hiroshima General Hospital, 
      Hiroshima, Japan.
FAU - Takahashi, Shinya
AU  - Takahashi S
AD  - Department of Cardiovascular Surgery, Hiroshima University, Hiroshima, Japan.
LA  - eng
PT  - Journal Article
DEP - 20220804
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
SB  - IM
MH  - Humans
MH  - Male
MH  - Aged
MH  - Female
MH  - Chronic Limb-Threatening Ischemia
MH  - Ischemia/diagnostic imaging/surgery
MH  - *Peripheral Arterial Disease/diagnostic imaging/surgery
MH  - Risk Factors
MH  - Treatment Outcome
MH  - Limb Salvage
MH  - Vascular Patency
MH  - Retrospective Studies
MH  - *Endovascular Procedures
OTO - NOTNLM
OT  - Chronic limb-threatening ischemia (CLTI)
OT  - Distal bypass
OT  - Global Vascular Guideline recommendation
OT  - Initial revascularization
OT  - Long-term outcomes
EDAT- 2022/08/08 06:00
MHDA- 2022/12/27 06:00
CRDT- 2022/08/07 19:36
PHST- 2022/03/11 00:00 [received]
PHST- 2022/06/20 00:00 [revised]
PHST- 2022/06/28 00:00 [accepted]
PHST- 2022/08/08 06:00 [pubmed]
PHST- 2022/12/27 06:00 [medline]
PHST- 2022/08/07 19:36 [entrez]
AID - S0741-5214(22)01950-4 [pii]
AID - 10.1016/j.jvs.2022.06.103 [doi]
PST - ppublish
SO  - J Vasc Surg. 2023 Jan;77(1):201-207. doi: 10.1016/j.jvs.2022.06.103. Epub 2022 
      Aug 4.