Bypass surgery better than endovascular treatment in chronic limb-threatening Ischemia

Intermittent claudication is usually treated conservatively. However, if conservative treatment fails and the patient is strongly disabled, invasive treatment can be considered. Percutaneous transluminal angioplasty (PTA) or bypass surgery are the possible treatment options for patients with chronic limb-threatening Ischemia. A decision-analysis, based on the results of cohort studies, advised PTA for stenosis or short occlusions, whereas vein bypass surgery was recommended for long occlusions. However, this recommendation was based on heterogeneous patient groups and the optimal method of treatment remains controversial. For this purpose researchers of Clinic for Vascular & Endovascular surgery, Serbia conducted a study to compare short and long term outcomes between PTA/S and OSB in CLTI patients with long (GLASS grade III and IV) femoropopliteal disease.

It was a two-centre retrospective study including all consecutive patients with CLTI undergoing first time lower extremity intervention at two distinct vascular surgical centres between 1 January 2012 and 1 January 2018. A total of 1545 CLTI consecutive limbs were treated for femoropopliteal GLASS grade III and IV lesions at two vascular surgical centres and among which some patients were randomly assigned to either OSB (n=235) or PTA/S (n=235). Researchers calculated the propensity score for each limb using covariables from baseline and angiographic characteristics. The major outcome analyzed were freedom from re-intervention in the treated extremity and major amputation. Researchers also analyzed all hospital complications among the two patient groups.

After treatment, the researchers found overall complication rates were significantly higher in the OSB group (20.42%) than in PTA/S group (5.96%). They also observed, wound infection/seroma rate that required prolonged hospitalisation and further treatment were require in patients of OSB group (7.65%) whereas it was absent in PTA/S group (0%). However, after the median follow-up of 61 months, they found re-intervention rates were significantly higher in the PTA/S group (log-rank test, 44.68% than in PTA/S group (29.79%). They also found no significant difference in major amputation rates between the two group of patients (PTA/S 27.23% vs. OSB 22.13%)

The authors concluded, "Bypass surgery seems to be superior to PTA/S for GLASS grade III and IV femoropopliteal lesions in patients with CLTI in terms of long term re-intervention rates, but with considerably higher rates of post-operative complications".

They further added, "A larger cohort of patients in currently ongoing randomised trials, as well as prospective cohort studies are necessary to confirm these findings".

For further information:

https://www.ejves.com/article/S1078-5884(20)31002-9/fulltext?rss=yes#%20