Comparison of angioplasty and bypass surgery for critical limb ischaemia in patients with infrapopliteal peripheral artery disease

BackgroundBoth 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. MethodsConsecutive 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. ResultsSome 279 limbs in 243 patients were included in the study. The two groups differed significantly with respect to the incidence of diabetes (P=0024), estimated glomerular filtration rate (P=0006), total lesion length (P<0001) and Rutherford classification (P=0008). These factors were used to construct the propensity score model, which yielded a matched cohort of 125 legs in each group. Primary patency (544 versus 514 per cent; P=0014), assisted primary patency (775 versus 627 per cent; P=0003), secondary patency (844 versus 658 per cent; P<0001) and amputation-free survival (787 versus 741 per cent; P=0043) were significantly better after bypass than angioplasty. However, limb salvage was similar (904 versus 942 per cent; P=0161), and overall complications (360 versus 216 per cent; P=0041) as well as length of hospital stay (18(4-134) versus 5(0-110); P=0001) were worse in the surgical bypass group. ConclusionThere was no difference in limb salvage rates, but patency and amputation-free survival rates were better 1 year after bypass surgery.