title: Comparison of angioplasty and bypass surgery for critical limb ischaemia in patients with infrapopliteal peripheral artery disease.
abstract: BACKGROUND
  Both infrapopliteal (IP) bypass surgery and percutaneous transluminal angioplasty have been shown to be effective in patients with critical limb ischaemia (CLI). The most appropriate method of revascularization has yet to be established, as no randomized trials have been reported. The aim of this study was to compare the outcomes of patients with similar characteristics treated using either revascularization method.
  
  
  METHODS
  Consecutive patients undergoing IP bypass and IP angioplasty for CLI (Rutherford 4-6) at a single institution were compared following propensity score matching. The study endpoints were primary, assisted primary and secondary patency, and amputation-free survival at 12 months, calculated by Kaplan-Meier analysis.
  
  
  RESULTS
  Some 279 limbs in 243 patients were included in the study. The two groups differed significantly with respect to the incidence of diabetes (P = 0·024), estimated glomerular filtration rate (P = 0·006), total lesion length (P < 0·001) and Rutherford classification (P = 0·008). These factors were used to construct the propensity score model, which yielded a matched cohort of 125 legs in each group. Primary patency (54·4 versus 51·4 per cent; P = 0·014), assisted primary patency (77·5 versus 62·7 per cent; P = 0·003), secondary patency (84·4 versus 65·8 per cent; P < 0·001) and amputation-free survival (78·7 versus 74·1 per cent; P = 0·043) were significantly better after bypass than angioplasty. However, limb salvage was similar (90·4 versus 94·2 per cent; P = 0·161), and overall complications (36·0 versus 21·6 per cent; P = 0·041) as well as length of hospital stay (18(4-134) versus 5(0-110); P = 0·001) were worse in the surgical bypass group.
  
  
  CONCLUSIONS
  There was no difference in limb salvage rates, but patency and amputation-free survival rates were better 1 year after bypass surgery.
authors.affiliation: Departments of Vascular and Endovascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: S D
authors.initials: SD
authors.lastname: Patel
authors.affiliation: Departments of Vascular and Endovascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Biasi
authors.affiliation: Departments of Interventional Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: I
authors.initials: I
authors.lastname: Paraskevopoulos
authors.affiliation: Departments of Vascular and Endovascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Silickas
authors.affiliation: Departments of Vascular and Endovascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: T
authors.initials: T
authors.lastname: Lea
authors.affiliation: Departments of Interventional Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Diamantopoulos
authors.affiliation: Departments of Interventional Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Katsanos
authors.affiliation: Departments of Vascular and Endovascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: H
authors.initials: H
authors.lastname: Zayed
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D017130:Angioplasty / Q000379:methods; D016638:Critical Illness; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D058729:Peripheral Arterial Disease / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome