Secondary interventions following open vs endovascular revascularization for chronic limb threatening ischemia in the...

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Clinical Trials

Background:

• Chronic limb-threatening ischemia (CLTI) frequently necessitates revascularization.
• Patients undergoing revascularization for CLTI often require subsequent target limb reinterventions.
• The Best Endovascular versus Best Surgical Therapy in Patients with Critical Limb Ischemia (BEST-CLI) trial provides a platform to compare treatment strategies.

Purpose of the Study:

• To analyze reintervention rates after initial open bypass (OPEN) versus endovascular (ENDO) treatment for CLTI.
• To compare major reinterventions, any reinterventions, and a composite endpoint of reintervention, amputation, or death.
• To evaluate the cumulative number of reinterventions over time in different patient cohorts.

Main Methods:

• A planned secondary analysis of the BEST-CLI randomized trial data.
• Intention-to-treat analysis comparing OPEN and ENDO strategies in two cohorts: with (cohort 1) and without (cohort 2) suitable single-segment great saphenous vein (SSGSV).
• Univariable and multivariable Cox regression models were used for comparisons.

Main Results:

• OPEN treatment was associated with significantly lower rates of major reintervention, any reintervention, and the composite endpoint in both cohorts.
• Early (30-day) reinterventions were higher in the ENDO group compared to OPEN in both cohorts.
• The mean number of reinterventions per year was significantly lower with OPEN, particularly in cohort 1 (with SSGSV).

Conclusions:

• Reintervention is a common occurrence after revascularization for CLTI.
• Initial open bypass surgery, especially with SSGSV, is linked to a substantially lower burden of target limb reinterventions compared to endovascular therapy.
• Treatment choice significantly impacts long-term reintervention rates in CLTI patients.