PMID- 37236536
OWN - NLM
STAT- MEDLINE
DCOM- 20231120
LR  - 20231120
IS  - 1615-5947 (Electronic)
IS  - 0890-5096 (Linking)
VI  - 97
DP  - 2023 Nov
TI  - Bypass Surgery Provides Better Outcomes Compared with Endovascular Therapy in 
      Patients with Chronic Limb-Threatening Ischemia Classified as Indeterminate 
      Category According to the Global Vascular Guidelines.
PG  - 358-366
LID - S0890-5096(23)00273-X [pii]
LID - 10.1016/j.avsg.2023.05.014 [doi]
AB  - BACKGROUND: The present study aimed to determine the preferred initial 
      revascularization procedure between bypass surgery and endovascular therapy (EVT) 
      in patients with chronic limb-threatening ischemia (CLTI) categorized as 
      indeterminate according to the Global Vascular Guidelines (GVG). METHODS: We 
      retrospectively analyzed the multicenter data of patients who underwent 
      infrainguinal revascularization for CLTI categorized as indeterminate according 
      to the GVG between 2015 and 2020. The end point was the composite of relief from 
      rest pain, wound healing, major amputation, reintervention, or death. RESULTS: A 
      total of 255 patients with CLTI and 289 limbs were analyzed. Of the 289 limbs, 
      110 (38.1%) and 179 (61.9%) underwent bypass surgery and EVT, respectively. The 
      2-year event-free survival rates with respect to the composite end point were 
      63.4% and 28.7% in the bypass and EVT groups, respectively (P < 0.01). 
      Multivariate analysis revealed that increased age (P = 0.03); decreased serum 
      albumin level (P = 0.02); decreased body mass index (P = 0.02); 
      dialysis-dependent end-stage renal disease (P < 0.01); increased Wound, Ischemia, 
      and foot Infection (WIfI) stage (P < 0.01); Global Limb Anatomic Staging System 
      (GLASS) III (P = 0.04); increased inframalleolar grade (P < 0.01); and EVT 
      (P < 0.01) were independent risk factors for the composite end point. In the 
      WIfI-GLASS 2-III and 4-II subgroups, bypass surgery was superior to EVT with 
      regard to 2-year event-free survival (P < 0.01). CONCLUSIONS: Bypass surgery is 
      superior to EVT in terms of the composite end point in patients classified as 
      indeterminate according to the GVG. Bypass surgery should be considered an 
      initial revascularization procedure, especially in the WIfI-GLASS 2-III and 4-II 
      subgroups.
CI  - Copyright (c) 2023 Elsevier Inc. All rights reserved.
FAU - Yoshino, Shinichiro
AU  - Yoshino S
AD  - Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu 
      University, Fukuoka, Japan.
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 - Kinoshita, Go
AU  - Kinoshita G
AD  - Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu 
      University, Fukuoka, Japan.
FAU - Matsubara, Yutaka
AU  - Matsubara Y
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 - 20230525
PL  - Netherlands
TA  - Ann Vasc Surg
JT  - Annals of vascular surgery
JID - 8703941
SB  - IM
MH  - Humans
MH  - *Chronic Limb-Threatening Ischemia
MH  - *Endovascular Procedures
MH  - Ischemia/diagnostic imaging/surgery
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Treatment Outcome
MH  - Multicenter Studies as Topic
EDAT- 2023/05/27 09:42
MHDA- 2023/11/13 06:42
CRDT- 2023/05/26 19:28
PHST- 2023/03/17 00:00 [received]
PHST- 2023/05/02 00:00 [revised]
PHST- 2023/05/10 00:00 [accepted]
PHST- 2023/11/13 06:42 [medline]
PHST- 2023/05/27 09:42 [pubmed]
PHST- 2023/05/26 19:28 [entrez]
AID - S0890-5096(23)00273-X [pii]
AID - 10.1016/j.avsg.2023.05.014 [doi]
PST - ppublish
SO  - Ann Vasc Surg. 2023 Nov;97:358-366. doi: 10.1016/j.avsg.2023.05.014. Epub 2023 
      May 25.