{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T01:16:51Z","timestamp":1777943811715,"version":"3.51.4"},"reference-count":37,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2022,6,14]],"date-time":"2022-06-14T00:00:00Z","timestamp":1655164800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Vascular"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The optimal management for revascularization after critical limb ischemia (CLI) is controversial due to limited studies comparing long-term results of endovascular and open techniques. This study compares long-term outcomes after initial management of CLI via lower extremity bypass (LEB) and percutaneous vascular intervention (PVI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study investigates outcomes of patients who underwent endovascular or open surgical management for CLI at a single institution from 2013\u20132018. All patients with diagnosis of CLI were included and separated based on initial therapy of PVI or LEB. Demographic, procedural, and follow-up data were assessed. Primary endpoints included major adverse limb events (MALE), specifically the need for major amputation and reintervention. Secondary endpoints included mortality at 30\u00a0days and one year. A multivariable Cox Proportional Hazard regression model was used to assess the relationship between Surgery group and time to MALE\/death while controlling for confounding variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>This study identified 338 patients with an initial diagnosis of CLI who underwent either LEB ( n = 108, 32%) or PVI ( n = 230, 68%). The average age was 71.4, 54.4% were male, 30% were African American, 53.6% were diabetic, and 93.2% had hypertension. Patients who underwent LEB were more predominantly smokers ( p = .003) and less predominantly on dialysis at time of surgery ( p = .01). Re-intervention rates in the bypass group (11%) were not significantly different than the PVI group (9%; p = .95). In the bypass group, 20 (19%) patients had a major amputation with a median time of 189.5\u00a0days compared to 23 (10%) patients at a median time of 113\u00a0days in the PVI group; however, this difference was not significant ( p = .16). There was no significant difference in 1-year mortality between the LEB (2%) and PVI group (4%; p = .2). The cumulative incidence of MALE\/death at 30 days was 4.0% in the bypass group and 3.7% in the PVI group ( p = .2). Incidences of MALE\/death were 21.1% and 48.5% in the bypass group and 19.7 and 45.9% in the PVI group at one and 2\u00a0years, respectively. Intervention type was not found to be significantly associated with MALE\/death after controlling for possible confounders (HR = 0.82, p = .43).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In the initial management of CLI, there is no significant difference in long-term outcomes in terms of major amputation, need for reintervention, limb-salvage, and 1-year mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17085381221107749","type":"journal-article","created":{"date-parts":[[2022,6,14]],"date-time":"2022-06-14T04:47:31Z","timestamp":1655182051000},"page":"1117-1123","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Contemporary outcomes of initial treatment strategy of endovascular intervention or bypass in patients with critical limb ischemia"],"prefix":"10.1177","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2276-8910","authenticated-orcid":false,"given":"Khalil","family":"Qato","sequence":"first","affiliation":[{"name":"Division of Vascular Surgery, Northwell Health, Glen Cove, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1048-2181","authenticated-orcid":false,"given":"Donna","family":"Bahroloomi","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, Lenox Hill Hospital, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allan","family":"Conway","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, Lenox Hill Hospital, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eileen","family":"Lu","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, Lenox Hill Hospital, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vicken","family":"Pamoukian","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, Lenox Hill Hospital, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gary","family":"Giangola","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, Lenox Hill Hospital, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alfio","family":"Carroccio","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, Lenox Hill Hospital, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,6,14]]},"reference":[{"key":"bibr1-17085381221107749","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2016.179"},{"key":"bibr2-17085381221107749","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2006.12.037"},{"key":"bibr3-17085381221107749","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2014.03.290"},{"key":"bibr4-17085381221107749","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.02.040"},{"key":"bibr5-17085381221107749","doi-asserted-by":"publisher","DOI":"10.1024\/0301-1526\/a000169"},{"key":"bibr6-17085381221107749","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.13623"},{"key":"bibr7-17085381221107749","doi-asserted-by":"publisher","DOI":"10.2147\/VHRM.S209241"},{"key":"bibr8-17085381221107749","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.027625"},{"key":"bibr9-17085381221107749","first-page":"A141","volume":"8","author":"Peacock 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