Bypass surgery the best way to limit amputations, death among CLTI patients
Bypass surgery is associated with fewer repeat procedures and amputations than endovascular treatment options such as angioplasty and stenting when treating patients with chronic limb-threatening ischemia (CLTI), according to new research presented Monday, Nov. 7, during the American Heart Association’s Scientific Sessions 2022 conference in Chicago. The study was simultaneously published in the New England Journal of Medicine.[1]
“We know the best guide for clinicians in caring for their patients is evidence-based decision making,” co-principal investigator Matthew Menard, MD, co-director of the endovascular surgery program at Brigham and Women’s Hospital, said in a prepared statement. “There’s a large body of evidence from randomized, controlled clinical trials that helps inform strategies for treating or preventing heart attacks and stroke, but up until now, there has been very little data to guide treatment decisions for peripheral artery disease and CLTI patients. The goal of our work is to try to fill in some of the key missing pieces.”
The BEST-CLI study included data from more than 1,800 CLTI patients. Patients with a high-quality single segment great saphenous vein (SSGSV) suitable for surgery were randomly chosen to either undergo bypass surgery or an endovascular procedure to restore blood flow. The nearly 400 patients who did not have a SSGSV suitable for surgery either underwent bypass surgery with a vein from their arm or an endovascular procedure.
Among patients with the SSGSV suitable for surgery, bypass surgery was associated with a 32% reduction in major adverse limb events or death compared to endovascular treatment. Diving deeper into the data, Menard et al. found that bypass surgery was also linked to 65% fewer repeat procedures and 27% fewer amputations.
Among the patients who did not have a SSGSV suitable for surgery, however, there was no significant difference in the risk of these key outcomes between surgery and endovascular therapy.
“For many patients with CLTI, clinicians may consider endovascular therapy first, but our study suggests that there shouldn’t be a one-size-fits-all approach to treatment,” co-principal investigator Kenneth Rosenfield, MD, head of the section of vascular medicine and intervention in the Massachusetts General Hospital cardiology division, said in the same statement. “What is clear from the data is that both surgical bypass and endovascular therapy are very effective and safe treatments, and that individualized, patient-level decision-making is very important.”
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.