AHA: Strategies Compared for Treating Chronic Limb-Threatening Ischemia

TUESDAY, Nov. 8, 2022 (HealthDay News) -- For patients with chronic limb-threatening ischemia (CLTI), an initial strategy of surgical revascularization is better than endovascular therapy for those with a single segment of great saphenous vein that could be used for surgery, according to a study published online Nov. 7 in the New England Journal of Medicine to coincide with the American Heart Association Scientific Sessions 2022, held from Nov. 5 to 7 in Chicago.

Alik Farber, M.D., from the Boston University School of Medicine, and colleagues conducted a randomized trial involving 1,830 patients with CLTI and infrainguinal peripheral artery disease in two parallel cohort trials. Cohort 1 included patients with a single segment of great saphenous vein that could be used for surgery and cohort 2 included patients who needed an alternative bypass conduit. A composite of major adverse limb event or death from any cause was assessed as the primary outcome.

The researchers found that after a median follow-up of 2.7 years, a primary outcome event occurred in 42.6 and 57.4 percent of patients in the surgical and endovascular groups, respectively, in cohort 1 (hazard ratio, 0.68; 95 percent confidence interval, 0.59 to 0.79; P < 0.001). After a median follow-up of 1.6 years, a primary outcome event occurred in 42.8 and 47.7 percent of patients in the surgical and endovascular groups, respectively, in cohort 2 (hazard ratio, 0.79; 95 percent confidence interval, 0.58 to 1.06; P = 0.12).

"Our findings support complementary roles for these two treatment strategies and emphasize the need for preprocedural planning to assess patients and inform what treatment is selected," Farber said in a statement.

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