Objective performance goals after open and endovascular intervention for critical limb ischaemia

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Clinical Outcomes Research

Background:

• Critical limb ischemia (CLI) poses significant risks, necessitating effective treatment strategies.
• Lower extremity bypass (LEB) and infrainguinal endovascular intervention (IEI) are primary revascularization methods for CLI.
• The Society for Vascular Surgery established objective performance goals (OPGs) to benchmark treatment efficacy.

Purpose of the Study:

• To evaluate if current real-world treatments for CLI, specifically LEB and IEI, align with established SVS OPGs.
• To compare perioperative and long-term outcomes of LEB and IEI against OPG benchmarks.
• To assess amputation-free survival (AFS) and patient survival rates for both interventions.

Main Methods:

• A comprehensive literature search was conducted in PubMed for studies published between 2010 and March 2021.
• Data from 82 publications on 35,981 IEI procedures and 49 publications on 26,707 LEB procedures were analyzed.
• Outcomes including perioperative adverse events, AFS, and patient survival were compared to SVS OPGs.

Main Results:

• Perioperative major adverse limb events showed no significant difference between IEI (9%) and LEB (10%) compared to OPG (8%).
• Perioperative major adverse cardiovascular events were significantly better for both IEI (4%) and LEB (6%) than OPG (8%).
• One-year AFS was 71% for IEI and 77% for LEB, while patient survival was 78% for IEI and 84% for LEB, with varying statistical significance against OPGs. Five-year survival and AFS did not differ significantly between LEB and IEI.

Conclusions:

• Real-world outcomes for infrainguinal endovascular intervention (IEI) and lower extremity bypass (LEB) largely align with Society for Vascular Surgery objective performance goals (OPGs).
• No significant differences were observed in 5-year outcomes between LEB and IEI for critical limb ischemia.
• Both LEB and IEI represent viable treatment options for CLI, meeting established performance benchmarks.