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Which Is Preferable for Chronic Limb-threatening Ischemia: Bypass versus Endovascular Therapy?

Mohammed Hamouda1, Kevin Yei1, Mahmoud B Malas1

  • 1Division of Vascular and Endovascular Surgery, Department of Surgery, UC San Diego, La Jolla, CA, USA.

Advances in Surgery
|August 5, 2026
PubMed

Insights

For chronic limb-threatening ischemia, open surgical bypass is recommended over endovascular therapy when patients have suitable anatomy and an adequate great saphenous vein, according to level 1 evidence.

Area of Science:

  • Vascular Surgery
  • Peripheral Arterial Disease Management

Background:

  • Chronic limb-threatening ischemia (CLTI) represents the most severe stage of peripheral arterial disease (PAD).
  • Revascularization is crucial for preventing limb loss in CLTI patients.
  • Treatment decisions involve balancing open surgical bypass and endovascular therapy.

Purpose of the Study:

  • To provide evidence-based guidance on selecting the optimal revascularization strategy for CLTI.
  • To define criteria for choosing between open bypass and endovascular intervention.

Main Methods:

  • Review of level 1 evidence comparing open surgical bypass and endovascular therapy for CLTI.
  • Analysis of patient-specific factors including anatomy, operative risk, and conduit availability.

Main Results:

  • Open surgical bypass is favored for patients suitable for both interventions with an adequate great saphenous vein.
  • Individualized patient assessment is key to treatment selection.

Conclusions:

  • Level 1 evidence supports open surgical bypass in select CLTI patients with suitable great saphenous vein.
  • Personalized treatment strategies are essential for optimal CLTI outcomes.

Keywords:
AmputationBypassChronic limb-threatening ischemiaEndovascular therapyLimb salvage

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