A Global Vascular Guidelines-Based Bypass-Preferred Population and Their Surgical Risk Among CLTI Patients Treated...

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Health Outcomes Research

Background:

• Chronic limb-threatening ischemia (CLTI) poses a significant risk of amputation and mortality.
• Endovascular therapy (EVT) is increasingly used for CLTI, but treatment selection criteria require ongoing evaluation.
• The Global Vascular Guidelines (GVG) provide a framework for choosing between bypass surgery and EVT.

Purpose of the Study:

• To assess the proportion of CLTI patients undergoing EVT who would be classified as bypass-preferred under GVG criteria.
• To evaluate the surgical risk within this bypass-preferred subgroup.
• To analyze the survival outcomes for bypass-preferred CLTI patients treated with EVT based on their surgical risk.

Main Methods:

• Analysis of 867 CLTI patients (WIfI stage ≥2) who underwent EVT (April 2010-December 2017).
• Stratification into bypass-preferred, indeterminate, or EVT-preferred groups using GVG criteria (severe wound, complex lesions).
• Surgical risk assessment using the modified PREVENT III score and survival decision tree analysis for mortality risk.

Main Results:

• 55% of CLTI patients undergoing EVT were classified as bypass-preferred according to GVG.
• A low-mortality risk subgroup within the bypass-preferred group had 80% survival at 2 years.
• 34% of this low-mortality subgroup were identified as high surgical risk by the PREVENT III score.

Conclusions:

• A substantial number of CLTI patients treated with EVT meet criteria for bypass preference under GVG.
• Survival outcomes for bypass-preferred CLTI patients treated with EVT did not significantly differ by surgical risk.
• These findings suggest a potential need to re-evaluate GVG application in select CLTI populations undergoing EVT.