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AHA: Strategies Compared for Treating Chronic Limb-Threatening Ischemia

Outcomes better for surgical revascularization versus endovascular therapy for those with single segment of great saphenous vein that could be used for surgery

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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