PMID- 37802402 OWN - NLM STAT- MEDLINE DCOM- 20240122 LR - 20240201 IS - 1097-6809 (Electronic) IS - 0741-5214 (Linking) VI - 79 IP - 2 DP - 2024 Feb TI - Comparison of limb outcomes between bypass surgery and endovascular therapy in dialysis-dependent and -independent patients with chronic limb-threatening ischemia. PG - 316-322.e2 LID - S0741-5214(23)02063-3 [pii] LID - 10.1016/j.jvs.2023.09.035 [doi] AB - OBJECTIVE: To examine limb salvage (LS) and wound healing in dialysis-dependent and -independent patients with chronic limb-threatening ischemia (CLTI) after infrainguinal bypass surgery or endovascular therapy (EVT). METHODS: We retrospectively analyzed the multi-center data of patients who underwent infrainguinal revascularization for CLTI with Wound, Ischemia, and foot Infection (WIfI) stage 2 to 4 between 2015 and 2020. The primary endpoint was LS. The secondary endpoint included wound healing, amputation-free survival (AFS), periprocedural complications, and 2-year survival. Comparison of these outcomes were made after propensity score matching. RESULTS: We analyzed 252 dialysis-dependent (318 limbs) and 305 dialysis-independent (354 limbs) patients. Propensity score matching extracted 202 pairs with no significant differences in characteristics. The LS rate in bypass surgery was better than that in EVT in dialysis-dependent patients (P < .001). There was no significant difference in the LS rates between bypass surgery and EVT in dialysis-independent patients (P = .168). The wound healing rate of bypass surgery was better than that of EVT both dialysis-dependent and -independent patients with CLTI. The AFS rate of bypass surgery was better than that of EVT in dialysis-dependent patients (P < .001). There was no significant difference in the AFS rates between bypass surgery and EVT in dialysis-independent patients (P = .099). There was no significant difference in the occurrence of Clavien-Dindo >/= IV and V between bypass surgery and EVT in dialysis-dependent and -independent patients. Age >/=75 years, serum albumin levels <3.5 g/dL, and non-ambulatory status were risk factors for 2-year mortality in dialysis-dependent patients. The 2-year survival rates in dialysis-dependent patients with risk factors of 0, 1, 2, and 3 were 82.5%, 67.1%, 49.5%, and 10.2%, respectively (P < .001). CONCLUSIONS: For LS and wound healing, bypass surgery was preferred for revascularization in dialysis-dependent patients with WIfI stage 2 to 4. Although dialysis dependency was one of the risk factors for 2-year mortality, dialysis-dependent patients, who have 0 to 1 risk factors, may benefit from bypass surgery, as 2-year survival of >50% is expected. 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 - Guntani, Atsushi AU - Guntani A AD - Department of Vascular Surgery, Saiseikai Yahata General Hospital, Kitakyushu, Japan. FAU - Matsuda, Daisuke AU - Matsuda D AD - Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, 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 - Yoshino, Shinichiro AU - Yoshino S AD - Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. FAU - Inoue, Kentaro AU - Inoue K AD - Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. FAU - Honma, Kenichi AU - Honma K AD - Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, 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 - 20231005 PL - United States TA - J Vasc Surg JT - Journal of vascular surgery JID - 8407742 SB - IM MH - Humans MH - Aged MH - Chronic Limb-Threatening Ischemia MH - Retrospective Studies MH - *Endovascular Procedures/adverse effects MH - Treatment Outcome MH - Renal Dialysis/adverse effects MH - Lower Extremity/blood supply MH - *Peripheral Arterial Disease/diagnostic imaging/surgery MH - Limb Salvage/adverse effects MH - Risk Factors MH - Ischemia/diagnostic imaging/surgery OTO - NOTNLM OT - Bypass surgery OT - Chronic limb-threatening ischemia (CLTI) OT - Dialysis-dependent OT - Major amputation OT - Two-year mortality OT - Wound healing COIS- Disclosures None. EDAT- 2023/10/07 00:42 MHDA- 2024/01/22 06:42 CRDT- 2023/10/06 19:29 PHST- 2023/06/23 00:00 [received] PHST- 2023/09/19 00:00 [revised] PHST- 2023/09/23 00:00 [accepted] PHST- 2024/01/22 06:42 [medline] PHST- 2023/10/07 00:42 [pubmed] PHST- 2023/10/06 19:29 [entrez] AID - S0741-5214(23)02063-3 [pii] AID - 10.1016/j.jvs.2023.09.035 [doi] PST - ppublish SO - J Vasc Surg. 2024 Feb;79(2):316-322.e2. doi: 10.1016/j.jvs.2023.09.035. Epub 2023 Oct 5.