Femoropopliteal balloon angioplasty vs. bypass surgery for CLI: a propensity score analysis.

OBJECTIVES: To compare the outcomes of femoropopliteal percutaneous transluminal angioplasty (PTA) and bypass surgery for critical limb ischaemia (CLI).

DESIGN: The study is retrospective in nature.

MATERIALS AND METHODS: This study included 858 consecutive patients, who underwent femoropopliteal revascularisation for CLI at Helsinki University Central Hospital during 2000-2007. As many as 517 patients (60%) underwent PTA and 341 (40%) bypass surgery. Propensity score analysis was used for risk adjustment in multivariable analysis and for one-to-one matching.

RESULTS: In the overall series, PTA had poorer long-term results than bypass (5-year leg salvage, 78.2% vs. 91.8%, p < 0.0001; survival 49.2% vs. 57.1%, p = 0.048; amputation-free survival, 42.0% vs. 53.7%, p = 0.003; freedom from surgical re-intervention 86.2% vs. 94.3%, p < 0.0001). When treatment method was adjusted for propensity score as well as in the propensity score-matched pairs, leg salvage and freedom from surgical re-intervention were worse after PTA than after bypass (among the 241 propensity score-matched pairs, 74.3% vs. 88.2%, p = 0.031, and 86.1% vs. 89.8%, p = 0.025, respectively). Differences in survival, amputation-free survival and freedom from any re-intervention were not observed.

CONCLUSIONS: In CLI patients, femoropopliteal PTA seems to be associated with poorer long-term leg salvage and freedom from surgical re-intervention than bypass surgery. However, the treatment method did not affect long-term amputation-free survival.