下膝窩慢性肢体切断危機に対する血管内治療と遠位下肢バイパスの比較

Chronic limb-threatening ischemia (CLTI) is the main cause of major amputation and associated morbidity and mortality. Currently, both endovascular and open surgical methods for below-the-knee (BTK) interventions result in unsatisfactorily short patency rates. The aim of this retrospective single-center study was to evaluate six-month and one-year primary patency and major amputation rate in patients with CLTI treated with distal-leg bypass or BTK endovascular intervention. Overall, 46 patients underwent BTK intervention and 32 were available for follow-up analysis. Nine surgical bypasses and 23 endovascular treatments (balloon angioplasty) were performed. Six-month and one-year primary patency was 5/9 (55%) after bypass and 18/23 (78%) and 16/23 (69%) following endovascular intervention (p=0.20 and p=0.46). Angiography findings, predominantly advanced atherosclerosis, precluded any secondary intervention attempts. At one year post-intervention, the incidence of major amputation was 3/9 (33%) after bypass surgery and 5/23 (22%) following endovascular treatment. Although endovascular intervention for BTK CLTI seems to offer better 12-month patency and lower incidence of major amputation compared to bypass surgery, no statistically significant difference was noted. A randomized trial with more subjects and longer follow-up should be undertaken.