Abstract：
OBJECTIVE: This study aimed to evaluate treatment outcomes after bypass surgery or endovascular therapy (EVT) in average- and high-risk patients with chronic limb-threatening ischemia (CLTI).
METHODS: We retrospectively analyzed multicenter data of patients who underwent infra-inguinal revascularization for CLTI between 2015 and 2022. A high-risk patient was defined as one with estimated 30-day mortality rate ≥5% or 2-year survival rate ≤50%, as determined by the Surgical Reconstruction vs Peripheral Intervention in Patients With Critical Limb Ischemia (SPINACH) calculator. The amputation-free survival (AFS), limb salvage (LS), wound healing, and 30-day mortality were compared separately for the average- and high-risk patients between the bypass and EVT with propensity score matching.
RESULTS: We analyzed 239 and 31 propensity score-matched pairs in the average- and high-risk patients with CLTI. In the average-risk patients, the 2-year AFS and LS rates were 78.1% and 94.4% in the bypass group and 63.0% and 87.7% in the EVT group (P < .001 and P = .007), respectively. The 1-year wound healing rates were 88.6% in the bypass group and 76.8% in the EVT group, respectively (P < .001). The 30-day mortality was 0.8% in the bypass surgery and 0.8% in the EVT group (P = .996). In the high-risk patients, there was no differences in the AFS, LS, and wound healing between the groups (P = .591, P = .148, and P = .074). The 30-day mortality was 3.2% in the bypass group and 3.2% in the EVT group (P = .991).
CONCLUSIONS: Bypass surgery is superior to EVT with respect to the AFS, LS, and wound healing in the average-risk patients. EVT is a feasible first-line treatment strategy for high-risk patients with CLTI undergoing revascularization, based on the lack of significant differences in the 2-year AFS rate, between the bypass surgery and EVT cohorts.
METHODS: We retrospectively analyzed multicenter data of patients who underwent infra-inguinal revascularization for CLTI between 2015 and 2022. A high-risk patient was defined as one with estimated 30-day mortality rate ≥5% or 2-year survival rate ≤50%, as determined by the Surgical Reconstruction vs Peripheral Intervention in Patients With Critical Limb Ischemia (SPINACH) calculator. The amputation-free survival (AFS), limb salvage (LS), wound healing, and 30-day mortality were compared separately for the average- and high-risk patients between the bypass and EVT with propensity score matching.
RESULTS: We analyzed 239 and 31 propensity score-matched pairs in the average- and high-risk patients with CLTI. In the average-risk patients, the 2-year AFS and LS rates were 78.1% and 94.4% in the bypass group and 63.0% and 87.7% in the EVT group (P < .001 and P = .007), respectively. The 1-year wound healing rates were 88.6% in the bypass group and 76.8% in the EVT group, respectively (P < .001). The 30-day mortality was 0.8% in the bypass surgery and 0.8% in the EVT group (P = .996). In the high-risk patients, there was no differences in the AFS, LS, and wound healing between the groups (P = .591, P = .148, and P = .074). The 30-day mortality was 3.2% in the bypass group and 3.2% in the EVT group (P = .991).
CONCLUSIONS: Bypass surgery is superior to EVT with respect to the AFS, LS, and wound healing in the average-risk patients. EVT is a feasible first-line treatment strategy for high-risk patients with CLTI undergoing revascularization, based on the lack of significant differences in the 2-year AFS rate, between the bypass surgery and EVT cohorts.
摘要：
目的：本研究旨在评估慢性威胁肢体缺血（CLTI）的一般和高危患者在搭桥手术或血管内治疗（EVT）后的治疗结果。
方法：我们回顾性分析了2015年至2022年间接受CLTI腹股沟下血管重建术患者的多中心数据。高危患者定义为30天死亡率≥5%或2年生存率≤50%的患者。根据临界肢体缺血（SPINACH）计算器的手术重建与周围介入治疗确定。无截肢生存（AFS），肢体抢救（LS），伤口愈合，在倾向评分匹配的情况下,分别比较了旁路手术和EVT之间的平均和高危患者的30天死亡率.
结果：我们分析了平均和高风险CLTI患者中239和31个倾向评分匹配对。在平均风险患者中，旁路组的2年AFS和LS率分别为78.1％和94.4％，EVT组分别为63.0％和87.7％（P<.001和P=.007），分别。1年伤口愈合率在旁路组88.6%,在EVT组76.8%,分别(P<.001)。搭桥手术组30天死亡率为0.8%，EVT组为0.8%（P=.996）。在高危患者中，战地战地战地没有差别,LS,两组之间的伤口愈合（P=.591，P=.148和P=.074）。旁路组30天死亡率为3.2%，EVT组为3.2%(P=.991)。
结论：在AFS方面，旁路手术优于EVT，LS,平均风险患者的伤口愈合。对于接受血运重建的CLTI高危患者，EVT是可行的一线治疗策略。基于2年AFS率缺乏显著差异，在搭桥手术和EVT队列之间。
方法：我们回顾性分析了2015年至2022年间接受CLTI腹股沟下血管重建术患者的多中心数据。高危患者定义为30天死亡率≥5%或2年生存率≤50%的患者。根据临界肢体缺血（SPINACH）计算器的手术重建与周围介入治疗确定。无截肢生存（AFS），肢体抢救（LS），伤口愈合，在倾向评分匹配的情况下,分别比较了旁路手术和EVT之间的平均和高危患者的30天死亡率.
结果：我们分析了平均和高风险CLTI患者中239和31个倾向评分匹配对。在平均风险患者中，旁路组的2年AFS和LS率分别为78.1％和94.4％，EVT组分别为63.0％和87.7％（P<.001和P=.007），分别。1年伤口愈合率在旁路组88.6%,在EVT组76.8%,分别(P<.001)。搭桥手术组30天死亡率为0.8%，EVT组为0.8%（P=.996）。在高危患者中，战地战地战地没有差别,LS,两组之间的伤口愈合（P=.591，P=.148和P=.074）。旁路组30天死亡率为3.2%，EVT组为3.2%(P=.991)。
结论：在AFS方面，旁路手术优于EVT，LS,平均风险患者的伤口愈合。对于接受血运重建的CLTI高危患者，EVT是可行的一线治疗策略。基于2年AFS率缺乏显著差异，在搭桥手术和EVT队列之间。
