title: Propensity score analysis of clinical outcome after bypass surgery vs. endovascular therapy for infrainguinal artery disease in patients with critical limb ischemia.
abstract: OBJECTIVE
  To compare endovascular therapy (EVT) outcomes to those of bypass surgery (BSG) for infrainguinal artery disease in patients with critical limb ischemia (CLI).
  
  
  METHODS
  A retrospective review was conducted of 1053 CLI patients (1053 first treated limbs) who underwent BSG (n=230) or EVT (n=823) for de novo infrainguinal lesions between January 2004 and December 2009 at 14 Japanese centers. Propensity score analysis was used for risk adjustment in multivariate analysis and for one-to-one matching (n=200 in each group). Amputation-free survival, overall survival, limb salvage, and freedom from major adverse limb events (any repeat revascularization or major amputation) were calculated.
  
  
  RESULTS
  Mean follow-up was 30±16 months. In the overall series, there was no significant difference at 3 years between the EVT and BSG groups in amputation-free survival (60.5% vs. 62.1%, p=0.84), limb salvage (88.7% vs. 85.4%, p=0.24), or overall survival (65.8% vs. 69.2%, p=0.40). However, freedom from adverse limb events was significantly lower in the EVT group (56.6% vs. 69.2%, p=0.02) at 3 years. In the matched pairs analysis, there was no significant difference in any outcome between BSG and EVT at 3 years: amputation-free survival 66.3% vs. 62.0 (p=0.44), limb salvage 88.8% vs. 84.8% (p=0.44), survival 73.8% vs. 68.8% (p=0.61), and freedom from adverse limb events 61.3% vs. 69.1% (p=0.27).
  
  
  CONCLUSIONS
  Our cohort suggested that the frequency of serious adverse events after EVT was comparable to that after BSG in CLI patients who underwent their first infrainguinal revascularization.
authors.affiliation: 1 Department of Cardiology, Kokura Memorial Hospital, Kitakyushu Japan.
authors.forename: Yoshimitsu
authors.initials: Y
authors.lastname: Soga
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Mii
authors.forename: Osamu
authors.initials: O
authors.lastname: Iida
authors.forename: Jin
authors.initials: J
authors.lastname: Okazaki
authors.forename: Sosei
authors.initials: S
authors.lastname: Kuma
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hirano
authors.forename: Kenji
authors.initials: K
authors.lastname: Suzuki
authors.forename: Daizo
authors.initials: D
authors.lastname: Kawasaki
authors.forename: Terutoshi
authors.initials: T
authors.lastname: Yamaoka
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kamoi
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Shintani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation; D016009:Chi-Square Distribution; D016638:Critical Illness; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D007564:Japan; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D016015:Logistic Models; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D057216:Propensity Score; D016016:Proportional Hazards Models; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D058017:Vascular Grafting / Q000009:adverse effects