Mohapatra A, et al. - Researchers performed a comparison of the effectiveness of pedal (inframalleolar) bypass vs endovascular tibial intervention for healing ischemic foot wounds secondary to tibial arterial disease. Compared with the “gold standard” of surgical bypass to a pedal target, endovascular tibial intervention was associated with poorer primary patency but similar secondary patency and wound healing rates. Researchers recommended considering endovascular intervention a lower risk alternative to pedal bypass in patients with tibial arterial disease.

Methods

• From 2006 and 2013, researchers performed a retrospective chart review of patients presenting with ischemic foot wounds and infrapopliteal arterial disease who underwent a revascularization procedure (either open surgical bypass to an inframalleolar target or endovascular tibial intervention).
• Collection of data on baseline demographics and comorbidities, procedural details, and postprocedure outcomes was performed.
• Successful healing of the index wound was assessed as the primary outcome measure.
• Mortality, major amputation, and patency were assessed as secondary outcomes.

Results

• Four hundred and seventeen patients met the eligibility criteria.
• Surgical bypass was performed on 105 patients and endovascular intervention on 312 patients, with mean follow-up of 25.0 and 20.2 months, respectively (P=.08).
• Patients who received endovascular treatment were older at baseline (P=.009), had higher rates of hyperlipidemia (P=.02), prior cerebrovascular accidents (P=.04), and smoking history (P=.04).
• No difference in 30 days postoperative mortality was observed (P=.31).
• However, bypass patients had longer hospital length of stay (P < .0001), higher rate of discharge to nursing facility (P < .001), and higher rates of myocardial infarctions (P=.03) and wound complications (P < .001).
• The rate of wound healing was 22.4% vs 29.0% in the bypass group vs endovascular group (P=.02), respectively at 6 months.
• In this study, survival at 1 year was higher after bypass (86.2% vs 70.4%; P < .0001).
• However, at 1 year, freedom from major amputation was similar (84.9% vs 82.8%; P=.42).
• The bypass group indicated higher primary patency (53.1% vs 38.2%; P=.002) and primary assisted patency (76.6% vs 51.7%; P < .0001).
• However, no difference in secondary patency (77.3% vs 73.8%; P=.13) was observed.