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Surgery or Endovascular Therapy for Chronic Limb-Threatening Ischemia.
Farber, Alik; Menard, Matthew T; Conte, Michael S; Kaufman, John A; Powell, Richard J; Choudhry, Niteesh K; Hamza, Taye H; Assmann, Susan F; Creager, Mark A; Cziraky, Mark J; Dake, Michael D; Jaff, Michael R; Reid, Diane; Siami, Flora S; Sopko, George; White, Christopher J; van Over, Max; Strong, Michael B; Villarreal, Maria F; McKean, Michelle; Azene, Ezana; Azarbal, Amir; Barleben, Andrew; Chew, David K; Clavijo, Leonardo C; Douville, Yvan; Findeiss, Laura; Garg, Nitin; Gasper, Warren; Giles, Kristina A; Goodney, Philip P; Hawkins, Beau M; Herman, Christine R; Kalish, Jeffrey A; Koopmann, Matthew C; Laskowski, Igor A; Mena-Hurtado, Carlos; Motaganahalli, Raghu; Rowe, Vincent L; Schanzer, Andres; Schneider, Peter A; Siracuse, Jeffrey J; Venermo, Maarit; Rosenfield, Kenneth.
Afiliação
  • Farber A; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Menard MT; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Conte MS; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Kaufman JA; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Powell RJ; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Choudhry NK; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Hamza TH; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Assmann SF; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Creager MA; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Cziraky MJ; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Dake MD; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Jaff MR; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Reid D; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Siami FS; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Sopko G; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • White CJ; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • van Over M; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Strong MB; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Villarreal MF; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • McKean M; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Azene E; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Azarbal A; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Barleben A; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Chew DK; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Clavijo LC; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Douville Y; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Findeiss L; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Garg N; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Gasper W; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Giles KA; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Goodney PP; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Hawkins BM; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Herman CR; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Kalish JA; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Koopmann MC; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Laskowski IA; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Mena-Hurtado C; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Motaganahalli R; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Rowe VL; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Schanzer A; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Schneider PA; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Siracuse JJ; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Venermo M; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
  • Rosenfield K; From the Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine (A.F., M.F.V., J.A. Kalish, J.J.S.), the Division of Vascular and Endovascular Surgery (M.T.M., M.B.S.) and the Department of Medicine (N.K.C.), Brigham and Women's Hospital, Harvard M
N Engl J Med ; 387(25): 2305-2316, 2022 12 22.
Article em En | MEDLINE | ID: mdl-36342173
BACKGROUND: Patients with chronic limb-threatening ischemia (CLTI) require revascularization to improve limb perfusion and thereby limit the risk of amputation. It is uncertain whether an initial strategy of endovascular therapy or surgical revascularization for CLTI is superior for improving limb outcomes. METHODS: In this international, randomized trial, we enrolled 1830 patients with CLTI and infrainguinal peripheral artery disease in two parallel-cohort trials. Patients who had a single segment of great saphenous vein that could be used for surgery were assigned to cohort 1. Patients who needed an alternative bypass conduit were assigned to cohort 2. The primary outcome was a composite of a major adverse limb event - which was defined as amputation above the ankle or a major limb reintervention (a new bypass graft or graft revision, thrombectomy, or thrombolysis) - or death from any cause. RESULTS: In cohort 1, after a median follow-up of 2.7 years, a primary-outcome event occurred in 302 of 709 patients (42.6%) in the surgical group and in 408 of 711 patients (57.4%) in the endovascular group (hazard ratio, 0.68; 95% confidence interval [CI], 0.59 to 0.79; P<0.001). In cohort 2, a primary-outcome event occurred in 83 of 194 patients (42.8%) in the surgical group and in 95 of 199 patients (47.7%) in the endovascular group (hazard ratio, 0.79; 95% CI, 0.58 to 1.06; P = 0.12) after a median follow-up of 1.6 years. The incidence of adverse events was similar in the two groups in the two cohorts. CONCLUSIONS: Among patients with CLTI who had an adequate great saphenous vein for surgical revascularization (cohort 1), the incidence of a major adverse limb event or death was significantly lower in the surgical group than in the endovascular group. Among the patients who lacked an adequate saphenous vein conduit (cohort 2), the outcomes in the two groups were similar. (Funded by the National Heart, Lung, and Blood Institute; BEST-CLI ClinicalTrials.gov number, NCT02060630.).
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Procedimentos Cirúrgicos Vasculares / Salvamento de Membro / Isquemia Crônica Crítica de Membro Tipo de estudo: Clinical_trials Limite: Humans Idioma: En Revista: N Engl J Med Ano de publicação: 2022 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Procedimentos Cirúrgicos Vasculares / Salvamento de Membro / Isquemia Crônica Crítica de Membro Tipo de estudo: Clinical_trials Limite: Humans Idioma: En Revista: N Engl J Med Ano de publicação: 2022 Tipo de documento: Article