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Clinical Outcomes in Patients with Chronic Limb-Threatening Ischemia Undergoing Tibial and Pedal Bypass with or

Taira Kobayashi1, Takanobu Okazaki1, Ryo Okusako1

  • 1Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hatsukaichi, Hiroshima, Japan.

Annals of Vascular Surgery
|February 15, 2026
PubMed

Insights

Routine coronary angiography before bypass surgery for chronic limb ischemia does not impact survival or major adverse cardiovascular events. This finding applies to patients fit for bypass, suggesting non-routine angiography may be suitable.

Area of Science:

  • Vascular Surgery
  • Cardiology
  • Clinical Outcomes Research

Background:

  • Chronic limb-threatening ischemia (CLTI) presents significant morbidity and mortality, primarily from cardiovascular events.
  • The necessity of routine coronary angiography (CAG) before surgical revascularization in CLTI patients without symptoms remains unclear.
  • This study investigates outcomes of tibial and pedal bypass in CLTI patients with or without preoperative routine CAG.

Purpose of the Study:

  • To compare hospital and long-term outcomes.
  • To evaluate the impact of routine versus non-routine CAG on CLTI patients undergoing bypass.
  • To assess overall survival and freedom from major adverse cardiovascular events (MACE).

Main Methods:

  • Retrospective review of CLTI patients undergoing tibial and pedal bypass (2013-2022).
  • Comparison between routine and non-routine CAG groups using inverse probability of treatment weighting (IPTW).
  • Primary endpoints: overall survival and freedom from MACE.

Main Results:

  • No significant differences in 30-day hospital death or MACE between routine and non-routine CAG groups post-IPTW.
  • Similar 3-year overall survival rates (63.9% vs. 65.2%) between groups.
  • Comparable 3-year freedom from MACE rates (76.8% vs. 74.3%) between groups.

Conclusions:

  • Routine preoperative coronary angiography does not significantly alter hospital or long-term outcomes for CLTI patients fit for bypass.
  • These findings suggest that a non-routine approach to CAG may be appropriate in select CLTI patients.
  • Outcomes including survival and MACE are similar regardless of routine CAG strategy.
Abstract

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