title: Femoropopliteal balloon angioplasty vs. bypass surgery for CLI: a propensity score analysis.
abstract: OBJECTIVE
  To compare the outcomes of femoropopliteal percutaneous transluminal angioplasty (PTA) and bypass surgery for critical limb ischaemia (CLI).
  
  
  METHODS
  The study is retrospective in nature.
  
  
  METHODS
  This study included 858 consecutive patients, who underwent femoropopliteal revascularisation for CLI at Helsinki University Central Hospital during 2000-2007. As many as 517 patients (60%) underwent PTA and 341 (40%) bypass surgery. Propensity score analysis was used for risk adjustment in multivariable analysis and for one-to-one matching.
  
  
  RESULTS
  In the overall series, PTA had poorer long-term results than bypass (5-year leg salvage, 78.2% vs. 91.8%, p < 0.0001; survival 49.2% vs. 57.1%, p = 0.048; amputation-free survival, 42.0% vs. 53.7%, p = 0.003; freedom from surgical re-intervention 86.2% vs. 94.3%, p < 0.0001). When treatment method was adjusted for propensity score as well as in the propensity score-matched pairs, leg salvage and freedom from surgical re-intervention were worse after PTA than after bypass (among the 241 propensity score-matched pairs, 74.3% vs. 88.2%, p = 0.031, and 86.1% vs. 89.8%, p = 0.025, respectively). Differences in survival, amputation-free survival and freedom from any re-intervention were not observed.
  
  
  CONCLUSIONS
  In CLI patients, femoropopliteal PTA seems to be associated with poorer long-term leg salvage and freedom from surgical re-intervention than bypass surgery. However, the treatment method did not affect long-term amputation-free survival.
authors.affiliation: Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland. maria.korhonen@helsinki.fi
authors.forename: M
authors.initials: M
authors.lastname: Korhonen
authors.forename: F
authors.initials: F
authors.lastname: Biancari
authors.forename: M
authors.initials: M
authors.lastname: Söderström
authors.forename: E
authors.initials: E
authors.lastname: Arvela
authors.forename: K
authors.initials: K
authors.lastname: Halmesmäki
authors.forename: A
authors.initials: A
authors.lastname: Albäck
authors.forename: M
authors.initials: M
authors.lastname: Lepäntalo
authors.forename: M
authors.initials: M
authors.lastname: Venermo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000401:mortality; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016009:Chi-Square Distribution; D003251:Constriction, Pathologic; D016638:Critical Illness; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005387:Finland; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery*; D057216:Propensity Score; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality