Endovascular therapy provides similar results of bypass graft surgery in the treatment of infrainguinal multilevel arterial disease in patients with chronic limb-threatening ischemia in all GLASS stages.

Abstract Purpose To compare the results of concomitant femoropopliteal and infrapopliteal percutaneous angioplasty / stenting (PTA/S) with distal bypass graft surgery (BGS) in patients with chronic limb-threatening ischemia (CLTI). Method In a single center retrospective investigation between 2011 and 2017, 668 revascularization procedures for CLTI were reviewed. Concomitant femoropopliteal and infrapopliteal disease was identified in 153 CLTI patients, treated with BGS (48) using autogenous veins as substitute or PTA/S in a single procedure (105). A subgroup of patients with complex, extensive arterial lesions (GLASS stage III) received additional analysis. Primary outcomes were limb salvage and survival. Results The mean follow-up time was of 21.4 months. Patients treated with PTA/S were significantly older and with predominance of females, diabetes and chronic kidney disease. Smoking was more common in patients treated with BGS. The BGS group showed a 36-month survival rate of 73.4%, while the PTA/S group presented a survival of 61.3% in the same interval (p=0.25). The 36-month cumulative limb salvage rate was of 53.3 and 59.7% for BGS and PTA/S, respectively (p=0.24). For GLASS stage III patients, 36-month limb salvage rates were 54.4% for PTA/S and 50.2%for BGS group (p=0.29). Multivariate analysis pointed poor runoff status (all endovascular patients) and diabetes (GLASS III endovascular patients) as risk factors for limb loss. Conclusion: PTA/S and BGS presented similar results of limb salvage and survival in the treatment of concomitant femoropopliteal and infrapopliteal arterial disease in patients with CLTI, even for patients with extensive and complex arterial disease.