Comparison of Wound Healing after Bypass Surgery versus Endovascular Therapy for Dialysis-Dependent or Independent Patients with Chronic Limb-Threatening Ischemia and Inframalleolar Disease: A Retrospective Cohort Study.

BACKGROUND: Patients with chronic limb-threatening ischemia (CLTI) and inframalleolar (IM) P1 disease present a substantial challenge, and the impact of dialysis on revascularization outcomes remains unclear. This study aimed to compare wound healing and limb salvage after bypass surgery (BSX) and endovascular therapy (EVT) in dialysis-dependent and dialysis-independent patients with CLTI and IM P1.

METHODS: We retrospectively analyzed the multicenter data from patients undergoing infrainguinal revascularization for CLTI with IM P1 between 2015 and 2023. Patients were categorized into 4 cohorts based on dialysis dependence and Wound, Ischemia, and foot Infection (WIfI) stages 3 and 4.

RESULTS: We reviewed collected data from 690 patients with CLTI and IM P1. After propensity score matching, we analyzed 42 dialysis-dependent patients with WIfI 3, 54 dialysis-dependent patients with WIfI 4, 41 dialysis-independent patients with WIfI 3, and 56 dialysis-independent patients with WIfI 4. In the dialysis-dependent cohort, BSX was associated with significantly higher wound healing rates than EVT in WIfI stages 3 and 4. In the dialysis-independent cohort, no significant difference in wound healing was observed between the groups in either WIfI stage. Overall survival did not significantly differ between BSX and EVT in any subgroup.

CONCLUSION: In summary, BSX may lead to better wound healing than EVT in dialysis-dependent patients with IM P1 disease and WIfI stages 3 and 4. No significant differences were observed between treatment strategies in dialysis-independent patients. Thus, BSX might be a preferable revascularization strategy in selected dialysis-dependent patients, although prospective studies are needed to confirm this result.