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Comparison of Clinical Outcomes in Patients Selected for Infra-Popliteal Bypass or Plain Balloon Angioplasty for Chronic Limb Threatening Ischemia Between 2009 and 2013
- Source :
- Vascular and Endovascular Surgery
- Publication Year :
- 2020
- Publisher :
- SAGE Publications, 2020.
-
Abstract
- Introduction: A published subgroup analysis of the Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL)-1 trial suggests that, in patients with chronic limb threatening ischemia (CLTI) due to infra-popliteal (IP) disease, clinical outcomes are better following vein bypass surgery (BS) than after plain balloon angioplasty (PBA). The aim of the present study is to determine if clinical outcomes following IP revascularization in our unit are concordant with those found in BASIL-1. Methods: We analyzed prospectively gathered data pertaining to 137 consecutive CLTI patients undergoing IP PBA or BS between 2009 and 2013. We compared 30-day morbidity and mortality, days in hospital (index admission and out to 12-months), amputation free survival (AFS), overall survival (OS), limb salvage (LS), and freedom from arterial re-intervention (FFR). Patient outcomes were censored on 1 February 2017, providing a minimum 3 years follow-up. Results: Patients undergoing BS (73/137, 47%) tended to be younger, have less comorbidity, and were more likely to be on best medical therapy (BMT). BS patients spent more days in hospital during the index admission (median 9 vs 5, p = .003), but not out to 12 months (median 15 vs 13, NS). BS patients suffered more 30-day morbidity (36% vs 10%, p < .001), mainly due to infective complications, but not mortality (3.1% vs 6.8%, NS). AFS (p = .001) and OS (p < .001), but not LS or FFR, were better after BS. Conclusions: CLTI patients selected for revascularization by means of IP BS had better long-term outcomes in terms of AFS and OS, but not FFR or LS. Although we await the results of the BASIL-2 trial, current data support the BASIL-1 sub-group analysis which suggests that patients requiring revascularization for IP disease should have BS where possible and that PBA should usually be reserved for patients who are not suitable for BS.
- Subjects :
- medicine.medical_specialty
infrapopliteal
Popliteal bypass
medicine.medical_treatment
Ischemia
Subgroup analysis
030204 cardiovascular system & hematology
Balloon
tibial
03 medical and health sciences
0302 clinical medicine
Angioplasty
medicine
In patient
chronic limb threatening ischemia
business.industry
030503 health policy & services
Original Articles
General Medicine
medicine.disease
Surgery
Bypass surgery
bypass surgery
endovascular
0305 other medical science
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 19389116 and 15385744
- Volume :
- 55
- Database :
- OpenAIRE
- Journal :
- Vascular and Endovascular Surgery
- Accession number :
- edsair.doi.dedup.....6986fb7c6e2ddf256e7d24857d45680c