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Acta clinica Croatica, Vol. 64. No. 2, 2025.

Original scientific paper

https://doi.org/10.20471/acc.2025.64.02.14

Comparison of Endovascular Intervention and Distal-Leg Bypass for Below-the-Knee Chronic Limb-Threatening Ischemia

Josip Figl orcid id orcid.org/0000-0001-6755-8656 ; Department of Surgery, Zagreb University Hospital Center, Zagreb, Croatia *
Ivan Škorak orcid id orcid.org/0000-0002-5499-1079 ; Department of Surgery, Zagreb University Hospital Center, Zagreb, Croatia
Dino Papeš ; Department of Surgery, Zagreb University Hospital Center, Zagreb, Croatia
Ivan Romić ; Department of Surgery, Zagreb University Hospital Center, Zagreb, Croatia
Suzana Figl ; Department of Surgery, Zagreb University Hospital Center, Zagreb, Croatia
Majda Vrkić Kirhmajer orcid id orcid.org/0000-0002-1340-1917 ; Department of Cardiology, Zagreb University Hospital Center, Zagreb, Croatia

* Corresponding author.

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Abstract

Chronic limb-threatening ischemia (CLTI) is the main cause of major amputation
and associated morbidity and mortality. Currently, both endovascular and open surgical methods
for below-the-knee (BTK) interventions result in unsatisfactorily short patency rates. The aim of this
retrospective single-center study was to evaluate six-month and one-year primary patency and major
amputation rate in patients with CLTI treated with distal-leg bypass or BTK endovascular intervention.
Overall, 46 patients underwent BTK intervention and 32 were available for follow-up analysis. Nine
surgical bypasses and 23 endovascular treatments (balloon angioplasty) were performed. Six-month and
one-year primary patency was 5/9 (55%) after bypass and 18/23 (78%) and 16/23 (69%) following
endovascular intervention (p=0.20 and p=0.46). Angiography findings, predominantly advanced atherosclerosis,
precluded any secondary intervention attempts. At one year post-intervention, the incidence of
major amputation was 3/9 (33%) after bypass surgery and 5/23 (22%) following endovascular treatment.
Although endovascular intervention for BTK CLTI seems to offer better 12-month patency and lower
incidence of major amputation compared to bypass surgery, no statistically significant difference was
noted. A randomized trial with more subjects and longer follow-up should be undertaken.

Keywords

Angioplasty; Endovascular treatment; Chronic limb-threatening ischemia; Limb salvage; Peripheral artery disease; Vascular bypass

Hrčak ID:

337598

URI

https://hrcak.srce.hr/337598

Publication date:

30.6.2025.

Article data in other languages: croatian

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