Comparison of Endovascular Intervention and Distal-Leg Bypass for Below-the-Knee Chronic Limb-Threatening Ischemia

Chronic limb-threatening ischemia (CLTI) is the main cause of major amputation and associated morbidity and mortality. Currently, both endovascular and open surgical methods for below-the-knee (BTK) interventions result in unsatisfactorily short patency rates. The aim of this retrospective single-center study was to evaluate six-month and one-year primary patency and major amputation rate in patients with CLTI treated with distal-leg bypass or BTK endovascular intervention. Overall, 46 patients underwent BTK intervention and 32 were available for follow-up analysis. Nine surgical bypasses and 23 endovascular treatments (balloon angioplasty) were performed. Six-month and one-year primary patency was 5/9 (55%) after bypass and 18/23 (78%) and 16/23 (69%) following endovascular intervention (p=0.20 and p=0.46). Angiography findings, predominantly advanced atherosclerosis, precluded any secondary intervention attempts. At one year post-intervention, the incidence of major amputation was 3/9 (33%) after bypass surgery and 5/23 (22%) following endovascular treatment. Although endovascular intervention for BTK CLTI seems to offer better 12-month patency and lower incidence of major amputation compared to bypass surgery, no statistically significant difference was noted. A randomized trial with more subjects and longer follow-up should be undertaken.