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Published on: September 22, 2020
Femoropopliteal balloon angioplasty vs. bypass surgery for CLI: a propensity score analysis
M Korhonen1, F Biancari, M Söderström
1Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland. maria.korhonen@helsinki.fi
Insights
Femoropopliteal angioplasty (PTA) showed poorer long-term leg salvage and re-intervention rates compared to bypass surgery for critical limb ischemia (CLI). However, amputation-free survival was similar between the two treatments.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Peripheral Artery Disease
Background:
- Critical limb ischemia (CLI) significantly impacts patient morbidity and mortality.
- Femoropopliteal revascularization is a key treatment for CLI.
- Percutaneous transluminal angioplasty (PTA) and bypass surgery are primary revascularization options.
Purpose of the Study:
- To compare the long-term outcomes of femoropopliteal PTA versus bypass surgery in patients with CLI.
- To evaluate differences in leg salvage, survival, amputation-free survival, and re-intervention rates.
Main Methods:
- Retrospective study of 858 consecutive patients undergoing femoropopliteal revascularization for CLI (2000-2007).
- Patients were divided into PTA (n=517) and bypass surgery (n=341) groups.
- Propensity score analysis was employed for risk adjustment and one-to-one matching.
Main Results:
- Overall, bypass surgery demonstrated superior 5-year leg salvage (91.8% vs. 78.2%) and freedom from surgical re-intervention (94.3% vs. 86.2%) compared to PTA.
- In propensity score-matched pairs, PTA was associated with significantly worse leg salvage (88.2% vs. 74.3%) and freedom from surgical re-intervention (89.8% vs. 86.1%).
- No significant differences were observed in overall survival or amputation-free survival between the two treatment groups.
Conclusions:
- Femoropopliteal PTA is associated with poorer long-term leg salvage and freedom from surgical re-intervention compared to bypass surgery in CLI patients.
- The choice of revascularization method did not significantly impact long-term amputation-free survival.
- Bypass surgery may be preferred for better limb salvage in select CLI patients.
Objectives:
To compare the outcomes of femoropopliteal percutaneous transluminal angioplasty (PTA) and bypass surgery for critical limb ischaemia (CLI).
Design:
The study is retrospective in nature.
Materials And Methods:
This study included 858 consecutive patients, who underwent femoropopliteal revascularisation for CLI at Helsinki University Central Hospital during 2000-2007. As many as 517 patients (60%) underwent PTA and 341 (40%) bypass surgery. Propensity score analysis was used for risk adjustment in multivariable analysis and for one-to-one matching.
Results:
In the overall series, PTA had poorer long-term results than bypass (5-year leg salvage, 78.2% vs. 91.8%, p < 0.0001; survival 49.2% vs. 57.1%, p = 0.048; amputation-free survival, 42.0% vs. 53.7%, p = 0.003; freedom from surgical re-intervention 86.2% vs. 94.3%, p < 0.0001). When treatment method was adjusted for propensity score as well as in the propensity score-matched pairs, leg salvage and freedom from surgical re-intervention were worse after PTA than after bypass (among the 241 propensity score-matched pairs, 74.3% vs. 88.2%, p = 0.031, and 86.1% vs. 89.8%, p = 0.025, respectively). Differences in survival, amputation-free survival and freedom from any re-intervention were not observed.
Conclusions:
In CLI patients, femoropopliteal PTA seems to be associated with poorer long-term leg salvage and freedom from surgical re-intervention than bypass surgery. However, the treatment method did not affect long-term amputation-free survival.
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