Outcomes of a bypass-first strategy in chronic limb-threatening ischemia based on the Global Vascular Guidelines

Area of Science:

• Vascular Surgery
• Peripheral Artery Disease
• Ischemia Management

Background:

• The Global Vascular Guidelines (GVG) provide recommendations for revascularization in chronic limb-threatening ischemia (CLTI).
• The decision for revascularization, particularly bypass versus endovascular therapy, is based on predicted outcomes.
• This study specifically evaluates outcomes following distal bypass in patients identified as candidates for bypass according to GVG criteria.

Purpose of the Study:

• To assess the real-world outcomes of distal bypass surgery in patients with CLTI who were recommended for bypass by the GVG.
• To compare outcomes between crural (leg) and pedal (foot) bypass procedures in this patient cohort.

Main Methods:

• A retrospective analysis of 239 distal bypass procedures for CLTI in 195 patients.
• Patients were selected based on a GVG bypass recommendation and treated between 2009 and 2020 at a single Japanese center.
• Outcomes including limb salvage, graft patency, wound healing, and survival were compared between crural and pedal bypasses.

Main Results:

• The cohort (195 patients, median age 77) underwent 133 crural and 106 pedal bypasses.
• 3-year limb salvage rate was 87%, with 3-year primary, assisted primary, and secondary patency rates of 40%, 65%, and 67%, respectively.
• 1-year wound healing rate was 88%. No significant differences in limb salvage, patency, or survival were observed between crural and pedal bypasses. 3-year survival was 52%.

Conclusions:

• Distal bypass surgery in CLTI patients with a GVG bypass recommendation yields acceptable limb salvage, graft patency, and survival rates.
• Outcomes were favorable regardless of whether the bypass was crural or pedal.
• The findings validate the GVG recommendation for bypass as an initial revascularization strategy in appropriate CLTI cases.