Related Experiment Video

Updated: Jun 10, 2025

Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg
00:09

Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg

Published on: November 19, 2019

8.6K

Vein bypass first vs. best endovascular treatment first revascularisation strategy for chronic limb-threatening

Catherine A Moakes1, Andrew W Bradbury2,3, Zainab Abdali1

  • 1Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK.

Health Technology Assessment (Winchester, England)
|October 14, 2024
PubMed

Insights

For chronic limb-threatening ischemia, a best endovascular treatment-first strategy improved amputation-free survival and reduced costs compared to vein bypass-first. This approach offers a more effective and economical solution for patients.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Health Economics

Background:

  • Chronic limb-threatening ischemia (CLTI) presents significant risks, including major amputation and death.
  • Atherosclerotic peripheral arterial disease is a common cause of CLTI requiring infra-popliteal revascularization.

Purpose of the Study:

  • To compare the clinical and cost-effectiveness of vein bypass-first versus best endovascular treatment-first strategies for CLTI.
  • To determine which revascularization strategy best prevents major amputation or death in patients with CLTI.

Main Methods:

  • A superiority, open-label, pragmatic, multicenter, phase III randomized trial involving 345 patients across UK, Sweden, and Denmark.
  • Patients with CLTI underwent infra-popliteal revascularization, randomized to either vein bypass-first or best endovascular treatment-first.
  • Primary outcome was amputation-free survival, with secondary outcomes including overall survival, major amputation rates, and quality of life. Cost-effectiveness and cost-utility analyses were performed.

Main Results:

  • Best endovascular treatment-first demonstrated superior amputation-free survival (53% vs 63% non-survival; adjusted HR 1.35, P=0.037) and lower mortality (45% vs 53% deaths; adjusted HR 1.37).
  • The best endovascular treatment-first strategy was associated with lower hospital costs (£1690 less) and improved quality-adjusted life-years (0.016 and 0.085 gain at 2 and 3 years).

Conclusions:

  • A best endovascular treatment-first revascularization strategy is clinically superior and more cost-effective for CLTI patients.
  • This approach leads to better amputation-free survival, driven by reduced mortality, and offers economic advantages over vein bypass-first.
Abstract

Keywords:
AMPUTATION FREE SURVIVALBEST ENDOVASCULAR TREATMENTCHRONIC LIMB THREATENING ISCHAEMIAINFRA-POPLITEALPERIPHERAL ARTERIAL DISEASERANDOMISED CONTROLLED TRIALVEIN BYPASS

More Related Videos

Reduction of Radiation Exposure during Endovascular Treatment of Peripheral Arterial Disease Combining Fiber Optic RealShape Technology and Intravascular Ultrasound13:48

Reduction of Radiation Exposure during Endovascular Treatment of Peripheral Arterial Disease Combining Fiber Optic RealShape Technology and Intravascular Ultrasound

Published on: April 21, 2023

1.4K
A Rabbit Venous Interposition Model Mimicking Revascularization Surgery using Vein Grafts to Assess Intimal Hyperplasia under Arterial Blood Pressure07:02

A Rabbit Venous Interposition Model Mimicking Revascularization Surgery using Vein Grafts to Assess Intimal Hyperplasia under Arterial Blood Pressure

Published on: May 15, 2020

5.7K

Related Concept Videos

Varicose Veins II: Diagnostic Studies and Interprofessional Care01:26

Varicose Veins II: Diagnostic Studies and Interprofessional Care

Varicose veins, or varicosities, develop when the valves in the veins, which control blood flow, weaken or damage. It causes blood to pool and the veins to enlarge. Understanding the clinical manifestations, diagnostic approaches, and management options for varicose veins is crucial for effective treatment and relief.Clinical manifestationsClinical manifestations of varicose veins include a heavy, achy feeling or pain after prolonged standing or sitting. This discomfort can often be relieved by...
4
Peripheral Artery Disease III: Interprofessional Care01:27

Peripheral Artery Disease III: Interprofessional Care

Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
3
Peripheral Artery Disease V: Postoperative Nursing Management01:23

Peripheral Artery Disease V: Postoperative Nursing Management

During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
4
Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies01:20

Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies

The key difference between Superficial Vein Thrombosis (SVT) and Deep Vein Thrombosis (DVT) lies in their location and severity.Clinical ManifestationsSVT typically presents with localized pain, tenderness, and redness along the course of a superficial vein, often accompanied by a palpable, cord-like structure under the skin. This condition is usually less dangerous than DVT but can be uncomfortable and may lead to complications such as cellulitis or, rarely, a clot extension into the deep...
3
Venous Thrombosis III: Interprofessional Care01:29

Venous Thrombosis III: Interprofessional Care

Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
3
Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation01:21

Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation

Clinical manifestationsPeripheral Arterial Disease (PAD) manifests through a range of symptoms, from the characteristic intermittent claudication to atypical presentations and severe complications in advanced stages. Intermittent claudication, a hallmark symptom of PAD, presents as exercise-induced muscle pain that typically resolves within minutes of rest. This pain is reproducible and stems from inadequate blood flow, leading to the accumulation of lactic acid produced during anaerobic...
3