COMPARISON OF CLINICAL OUTCOME OF BYPASS SURGERY VERSUS BELOW-THE-KNEE ANGIOPLASTY AND STENTING IN INFRAPOPLITEAL LESIONS THAT RESULTS IN ULCER OR TOE GANGRENE
Abstract
Introduction. Chronic limb-threatening Ischaemia (CLTI) is a manifestation of peripheral arterial disease (PAD) that includes chronic ischemic rest pain or Ischaemic skin lesions, ulcers, or gangrene for longer than two weeks. Although infrapopliteal angioplasty may salvage the majority of limbs under threat of amputation. Endovascular interventions in the infrapopliteal vasculature may improve symptoms in patients with CLTI by re-establishing in-line blood flow to the foot. The optimal revascularization strategy for patients with severe leg ischemia remains uncertain. The purpose of this study was to compare outcomes of bypass surgery and angioplasty in isolated below-the-knee lesions. Materails and methods. Patients with ulcers or toe gangrenes, undergone below-the-knee bypass surgery or angioplasty and stenting from 2022 to 2023, were included in the study. Amputation-free survival (AFS) and overall survival (OS) were assessed using the Kaplan–Meier and Cox regression tests. Results. Three hundred ten (310) patients were included in this study, of which 259 patients underwent balloon angioplasty and popliteal artery stenting, 51 patients underwent bypass surgery. The mean age in the bypass group was 73.1 (±7.1) years and 73.9 (±7.2) years in the angioplasty and stenting group. There were no significant differences in gender, diabetes, hypertension, history of smoking, history of stroke, and renal insufficiency between the three groups. AFS was 43.4 (±8.5) months in the bypass group and 39.8 (±8.9) months in the angioplasty and stenting group which was significantly better in the bypass group (p=0.05). OS was 49.6 (±10.6) months in the bypass group and 46.2 (±11.7) months in the angioplasty and stenting group but did not differ statistically significant (p=0.32). Conclusion. AFS was significantly higher in the bypass group. Thus, bypass surgery seems preferable to angioplasty for all patients with severe leg ischemia except those with multiple comorbidities and those whose vein is not adequate for bypass.
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