Percutaneous Vascular Interventions Versus Bypass Surgeries in Patients With Critical Limb Ischemia: A Comprehensive...

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Critical Limb Ischemia Treatment

Background:

• Treatment strategies for critical limb ischemia (CLI) remain controversial.
• Previous reviews lacked strict inclusion criteria, potentially biasing results.
• The optimal revascularization strategy for CLI requires further investigation.

Purpose of the Study:

• To compare percutaneous vascular interventions (PVI) against bypass surgeries (BSX) in patients with critical limb ischemia (CLI).
• To evaluate the efficacy and safety of PVI versus BSX for CLI revascularization.
• To provide evidence-based recommendations for CLI treatment strategies.

Main Methods:

• Meta-analysis of randomized controlled trials and observational clinical studies.
• Inclusion criteria focused exclusively on patients with critical limb ischemia (CLI).
• Primary endpoints included overall survival, amputation-free survival, 30-day mortality, and major adverse cardiovascular and cerebrovascular events.

Main Results:

• PVI reduced 30-day mortality, major adverse events, and surgical site infections compared to BSX.
• PVI increased risks of long-term all-cause mortality and primary patency failure.
• PVI showed inferior outcomes compared to autogenous bypass surgery for infrapopliteal lesions.

Conclusions:

• Bypass surgery (BSX) may be a better long-term option for CLI patients in good physical condition with long life expectancy, especially with autogenous grafts.
• Enhanced perioperative care for BSX is crucial to match PVI's short-term outcomes.
• The choice between PVI and BSX should be individualized based on patient factors and lesion characteristics.