PMID- 38522583
OWN - NLM
STAT- Publisher
LR  - 20240425
IS  - 1097-6809 (Electronic)
IS  - 0741-5214 (Linking)
DP  - 2024 Mar 24
TI  - Infra-inguinal bypass surgery vs endovascular revascularization for chronic 
      limb-threatening ischemia in average- and high-risk patients.
LID - S0741-5214(24)00505-6 [pii]
LID - 10.1016/j.jvs.2024.03.025 [doi]
AB  - OBJECTIVE: This study aimed to evaluate treatment outcomes after bypass surgery 
      or endovascular therapy (EVT) in average- and high-risk patients with chronic 
      limb-threatening ischemia (CLTI). METHODS: We retrospectively analyzed 
      multicenter data of patients who underwent infra-inguinal revascularization for 
      CLTI between 2015 and 2022. A high-risk patient was defined as one with estimated 
      30-day mortality rate >/=5% or 2-year survival rate </=50%, as determined by the 
      Surgical Reconstruction vs Peripheral Intervention in Patients With Critical Limb 
      Ischemia (SPINACH) calculator. The amputation-free survival (AFS), limb salvage 
      (LS), wound healing, and 30-day mortality were compared separately for the 
      average- and high-risk patients between the bypass and EVT with propensity score 
      matching. RESULTS: We analyzed 239 and 31 propensity score-matched pairs in the 
      average- and high-risk patients with CLTI. In the average-risk patients, the 
      2-year AFS and LS rates were 78.1% and 94.4% in the bypass group and 63.0% and 
      87.7% in the EVT group (P < .001 and P = .007), respectively. The 1-year wound 
      healing rates were 88.6% in the bypass group and 76.8% in the EVT group, 
      respectively (P < .001). The 30-day mortality was 0.8% in the bypass surgery and 
      0.8% in the EVT group (P = .996). In the high-risk patients, there was no 
      differences in the AFS, LS, and wound healing between the groups (P = .591, P = 
      .148, and P = .074). The 30-day mortality was 3.2% in the bypass group and 3.2% 
      in the EVT group (P = .991). CONCLUSIONS: Bypass surgery is superior to EVT with 
      respect to the AFS, LS, and wound healing in the average-risk patients. EVT is a 
      feasible first-line treatment strategy for high-risk patients with CLTI 
      undergoing revascularization, based on the lack of significant differences in the 
      2-year AFS rate, between the bypass surgery and EVT cohorts.
CI  - Copyright (c) 2024 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 - Kinoshita, Go
AU  - Kinoshita G
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 - 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 - 20240324
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
SB  - IM
OTO - NOTNLM
OT  - Amputation-free survival
OT  - Bypass surgery
OT  - Chronic limb-threatening ischemia (CLTI)
OT  - Endovascular therapy
OT  - Risk assessment
COIS- Disclosures None.
EDAT- 2024/03/25 00:42
MHDA- 2024/03/25 00:42
CRDT- 2024/03/24 20:26
PHST- 2024/02/14 00:00 [received]
PHST- 2024/03/14 00:00 [revised]
PHST- 2024/03/15 00:00 [accepted]
PHST- 2024/03/25 00:42 [pubmed]
PHST- 2024/03/25 00:42 [medline]
PHST- 2024/03/24 20:26 [entrez]
AID - S0741-5214(24)00505-6 [pii]
AID - 10.1016/j.jvs.2024.03.025 [doi]
PST - aheadofprint
SO  - J Vasc Surg. 2024 Mar 24:S0741-5214(24)00505-6. doi: 10.1016/j.jvs.2024.03.025.