title: Comparative effectiveness of peripheral vascular intervention versus surgical bypass for critical limb ischemia in the Vascular Study Group of Greater New York.
abstract: OBJECTIVE
  In this study, the effectiveness of peripheral vascular intervention (PVI) was compared with surgical bypass grafting (BPG) for critical limb ischemia (CLI) in the Vascular Study Group of Greater New York (VSGGNY).
  
  
  METHODS
  Patients undergoing BPG or PVI for CLI at VSGGNY centers (2011-2013) were included. The Society for Vascular Surgery objective performance goals for CLI were used to directly compare the safety and effectiveness of PVI and BPG. Propensity score matching was used for risk-adjusted comparisons of PVI with BPG.
  
  
  RESULTS
  A total of 414 patients (268 PVI, 146 BPG) were treated for tissue loss (69%) or rest pain (31%). Patients undergoing PVI were more likely to have tissue loss (74.6% vs 57.5%; P < .001) and comorbidities such as diabetes (69.3% vs 57.5%; P = .02), heart failure (22% vs 13.7%; P = .04), and severe renal disease (13.1% vs 4.1%; P = .004). No significant differences were found between the groups across a panel of safety objective performance goals. In unadjusted analyses at 1 year, BPG was associated with higher rates of freedom from reintervention, amputation, or restenosis (90.4% vs 81.7%; P = .02) and freedom from reintervention or amputation (92.5% vs 85.8%, P = .045). After propensity score matching, PVI was associated with improved freedom from major adverse limb events and postoperative death at 1 year (95.6% vs 88.5%; P < .05).
  
  
  CONCLUSIONS
  By unadjusted comparison, early reintervention and restenosis are more prevalent with PVI. However, risk-adjusted comparison underscores the safety and effectiveness of PVI in the treatment of CLI.
authors.affiliation: Division of Vascular Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY. Electronic address: ajm9007@med.cornell.edu.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Meltzer
authors.affiliation: Division of Vascular Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY.
authors.forename: Art
authors.initials: A
authors.lastname: Sedrakyan
authors.affiliation: Division of Vascular Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY.
authors.forename: Abby
authors.initials: A
authors.lastname: Isaacs
authors.affiliation: Division of Vascular Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Connolly
authors.affiliation: Division of Vascular Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY.
authors.forename: Darren B
authors.initials: DB
authors.lastname: Schneider
authors.affiliation: Division of Vascular Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY.
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D057186:Comparative Effectiveness Research; D016638:Critical Illness; D016208:Databases, Factual; D018572:Disease-Free Survival; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007511:Ischemia / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D009519:New York City; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D057216:Propensity Score; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D055815:Young Adult