title: Is atherectomy the best first-line therapy for limb salvage in patients with critical limb ischemia?
abstract: OBJECTIVE
  To determine the efficacy of atherectomy for limb salvage compared with open bypass in patients with critical limb ischemia.
  
  
  METHODS
  Ninety-nine consecutive bypass and atherectomy procedures performed for critical limb ischemia between January 2003 and October 2006 were reviewed.
  
  
  RESULTS
  A total of 99 cases involving TASC C (n = 43, 44%) and D (n = 56, 56%) lesions were treated with surgical bypass in 59 patients and atherectomy in 33 patients. Bypass and atherectomy achieved similar 1-year primary patency (64% vs 63%; P = .2). However, the 1-year limb salvage rate was greater in the bypass group (87% vs 69%; P = .004). In the tissue loss subgroup, there was a greater limb salvage rate for bypass patients versus atherectomy (79% vs 60%; P = .04).
  
  
  CONCLUSIONS
  Patients with critical limb ischemia may do better with open bypass compared with atherectomy as first-line therapy for limb salvage.
authors.affiliation: Department of Vascular Surgery, University of Chicago, Chicago, Illinois, USA.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Loor
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Skelly
authors.forename: Carl-Magnus
authors.initials: CM
authors.lastname: Wahlgren
authors.forename: Hisham S
authors.initials: HS
authors.lastname: Bassiouny
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Piano
authors.forename: Wael
authors.initials: W
authors.lastname: Shaalan
authors.forename: Tina R
authors.initials: TR
authors.lastname: Desai
mesh_terms: D000368:Aged; D017073:Atherectomy / Q000009:adverse effects / Q000401:mortality; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D016638:Critical Illness; D005260:Female; D006801:Humans; D007511:Ischemia / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D014680:Veins / Q000637:transplantation