Bypass Surgery versus Endovascular Therapy for Lower Limb Ischemia Due to Infragenicular Lesions

Background: Endovascular and open surgical revascularization are delivered to patients by a variety of vascular specialists. Critical limb ischemia (CLI) is compounded by the fact that there is limited high quality data guiding vascular specialists on the optimal treatment approach.
Objective: The aim of the present study was to assess the better management of patients with critical lower limb ischemia.
Patients and methods: This study included 24 participants diagnosed with critical lower limb ischemia (CLI) due to Infragenicular lesions. They were allocated into two groups: group (1), which include 12 patients undergoing the endovascular therapy (EVT) and group (2) that include 12 patients undergoing the bypass surgical therapy.  All patients were subjected to radiological evaluation including X-ray foot, arterial Duplex U-S on affected limb, CT angiography on lower limb arteries and the saphenous vein. The patients followed an appropriate risk factor modification program.
Results: There was no significant difference between the studied groups regards Rutherford classifications (p > 0.05). There was a statistically significant increase in frequency of amputation among EVT group versus bypass group (p = 0.04). Furthermore, there was a statistically significant increase in frequency of thrombosis among EVT group versus bypass group (p = 0.03). On the other hand, there was no statistically significant difference between the studied groups that underwent different surgical techniques regarding complications. Kaplan Meier curve showed cumulative survival from major amputation following infrapopliteal angioplasty and bypass treatment over the study period.
Conclusion: Endovascular intervention is considered a safe and efficient technique in the treatment of critical limb ischemia. The technique has many advantages over open surgical procedures, being tolerable, easy, safe, and effective with general anesthesia avoidance and has low mortality and morbidity.