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The ongoing battle between infrapopliteal angioplasty and bypass surgery for critical limb ischemia

Katja B C Schamp1, Robbert Meerwaldt, Michel M P J Reijnen

  • 1Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.

Annals of Vascular Surgery
|July 28, 2012
PubMed

Insights

Critical limb ischemia (CLI) treatment via infrapopliteal angioplasty or bypass surgery offers similar limb salvage rates. Bypass surgery shows better patency, but both are complementary for peripheral arterial occlusive disease.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Peripheral Arterial Disease

Background:

  • Critical limb ischemia (CLI) is a severe manifestation of peripheral arterial occlusive disease, linked to high mortality.
  • Limb salvage in CLI typically involves infrapopliteal revascularization through angioplasty or bypass surgery.
  • Endovascular treatments have gained prominence in CLI management over the last decade.

Purpose of the Study:

  • To review the clinical outcomes, treatment strategies, and limitations of angioplasty versus bypass surgery for infrapopliteal revascularization in CLI.
  • To compare the efficacy of endovascular angioplasty and traditional bypass surgery in limb salvage and patency rates.
  • To identify gaps in current research and suggest future directions for CLI treatment algorithms.

Main Methods:

  • A comprehensive literature search was conducted using PubMed and Cochrane databases.
  • Included studies focused on infrapopliteal arterial revascularization treatments for CLI.
  • Articles published up to September 2011 were considered for the review.

Main Results:

  • Both angioplasty and bypass surgery achieve approximately 80% limb salvage at 3 years.
  • Bypass surgery demonstrated higher patency rates compared to angioplasty.
  • Direct comparison is challenging due to confounding factors like patient selection, lesion characteristics, and complication rates.

Conclusions:

  • Infrapopliteal angioplasty and bypass surgery offer acceptable limb salvage rates for CLI.
  • Bypass surgery appears to provide superior patency, though both methods are likely complementary.
  • Further randomized trials are needed to establish definitive treatment algorithms for CLI patients with infrapopliteal arterial occlusive disease.
Abstract

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