PMID- 37076109 OWN - NLM STAT- MEDLINE DCOM- 20230724 LR - 20230724 IS - 1097-6809 (Electronic) IS - 0741-5214 (Linking) VI - 78 IP - 2 DP - 2023 Aug TI - Treatment outcomes between bypass surgery and endovascular therapy in patients with chronic limb-threatening ischemia classified as bypass-preferred category based on Global Vascular Guidelines. PG - 475-482.e1 LID - S0741-5214(23)01026-1 [pii] LID - 10.1016/j.jvs.2023.04.006 [doi] AB - OBJECTIVE: The aim of this study was to examine outcomes between bypass surgery and endovascular therapy (EVT) in patients with chronic limb-threatening ischemia (CLTI), classified as bypass-preferred according to the Global Vascular Guidelines (GVG). METHODS: We retrospectively analyzed the multi-center data of patients who underwent infrainguinal revascularization for CLTI with Wound, Ischemia, and foot Infection (WIfI) Stage 3 to 4 and Global Limb Anatomical Staging System (GLASS) Stage III, which is classified as bypass-preferred category by the GVG between 2015 and 2020. The endpoints were limb salvage and wound healing. RESULTS: We analyzed 301 patients and 339 limbs following 156 bypass surgeries and 183 EVTs. The 2-year limb salvage rates were 92.2% in the bypass surgery group and 76.3% in the EVT group, respectively (P < .01). The 1-year wound healing rates were 86.7% in the bypass surgery group and 67.8% in the EVT group (P < .01). Multivariate analysis shows decreased serum albumin level (P < .01), increased wound grade (P = .04), and EVT (P < .01) were risk factors for major amputation. Decreased serum albumin level (P < .01), increased wound grade (P < .01), GLASS infrapopliteal grade (P = .02), inframalleolar (IM) P grade (P = .01), and EVT (P < .01) were risk factors for impaired wound healing. Subgroup analysis of limb salvage in patients after EVT, decreased serum albumin level (P < .01), increased wound grade (P = .03), increased IM P grade (P = .04), and congestive heart failure (P < .01) were risk factors for major amputation. According to scoring by existence of these risk factors, 2-year limb salvage rates following EVT were 83.0% and 42.8% for the total score of 0 to 2 and of 3 to 4, respectively (P < .01). CONCLUSIONS: Bypass surgery provides better limb salvage and wound healing in patients with WIfI Stage 3 to 4 and GLASS Stage III, which is classified as bypass-preferred category by the GVG. In patients after EVT, serum albumin level, wound grade, IM P grade, and congestive heart failure were related to major amputation. Although bypass surgery may be considered as initial revascularization procedure in patients classified as bypass-preferred category, in case that EVT has to be selected, relatively acceptable outcomes can be expected in patients with less of these risk factors. CI - Copyright (c) 2023 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved. FAU - Morisaki, Koichi AU - Morisaki K AD - Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. Electronic address: morisaki.koichi.533@m.kyushu-u.ac.jp. FAU - Matsuda, Daisuke AU - Matsuda D AD - Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan. FAU - Guntani, Atsushi AU - Guntani A AD - Department of Vascular Surgery, Saiseikai Yahata General Hospital, Kitakyushu, Japan. FAU - Matsubara, Yutaka AU - Matsubara Y AD - Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. FAU - Kinoshita, Go AU - Kinoshita G AD - Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. FAU - Kawanami, Shogo AU - Kawanami S AD - Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. FAU - Yamashita, Sho AU - Yamashita S AD - Department of Vascular Surgery, Saiseikai Yahata General Hospital, Kitakyushu, Japan. FAU - Honma, Kenichi AU - Honma K AD - Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan. FAU - Furuyama, Tadashi AU - Furuyama T AD - Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. FAU - Yamaoka, Terutoshi AU - Yamaoka T AD - Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan. FAU - Mii, Shinsuke AU - Mii S AD - Department of Vascular Surgery, Saiseikai Yahata General Hospital, Kitakyushu, Japan. FAU - Komori, Kimihiro AU - Komori K AD - Department of Vascular Surgery, Saiseikai Yahata General Hospital, Kitakyushu, Japan. FAU - Yoshizumi, Tomoharu AU - Yoshizumi T AD - Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. LA - eng PT - Journal Article DEP - 20230417 PL - United States TA - J Vasc Surg JT - Journal of vascular surgery JID - 8407742 RN - 0 (Serum Albumin) SB - IM MH - Humans MH - Chronic Limb-Threatening Ischemia MH - Retrospective Studies MH - *Peripheral Arterial Disease/diagnostic imaging/surgery MH - Chronic Disease MH - Treatment Outcome MH - Limb Salvage/methods MH - Ischemia/diagnostic imaging/surgery MH - Risk Factors MH - *Endovascular Procedures/adverse effects MH - Serum Albumin OTO - NOTNLM OT - Bypass-preferred OT - Chronic limb-threatening ischemia (CLTI) OT - Global Vascular Guidelines (GVG) OT - Major amputation OT - Wound healing EDAT- 2023/04/20 00:41 MHDA- 2023/07/24 06:42 CRDT- 2023/04/19 19:28 PHST- 2023/03/10 00:00 [received] PHST- 2023/03/29 00:00 [revised] PHST- 2023/04/07 00:00 [accepted] PHST- 2023/07/24 06:42 [medline] PHST- 2023/04/20 00:41 [pubmed] PHST- 2023/04/19 19:28 [entrez] AID - S0741-5214(23)01026-1 [pii] AID - 10.1016/j.jvs.2023.04.006 [doi] PST - ppublish SO - J Vasc Surg. 2023 Aug;78(2):475-482.e1. doi: 10.1016/j.jvs.2023.04.006. Epub 2023 Apr 17.