OBJECTIVE: BEST-CLI established the superiority of single-segment great saphenous vein (ssGSV) conduits for revascularization in patients with chronic limb-threatening ischemia (CLTI)
however, the generalizability of these data is unknown. Thus, we aimed to validate the long-term results of open surgical bypass (BPG) vs percutaneous transluminal angioplasty with or without stenting (PTA/S) using the BEST-CLI inclusion and randomization criteria. METHODS: All patients undergoing a first-time lower extremity revascularization for CLTI at our institution from 2005 to 2022 were retrospectively reviewed. To approximate BEST-CLI, one-to-one propensity score matching was used. Cohort 1 included BPG with ssGSV vs PTA/S
Cohort 2 included BPG without ssGSV vs PTA/S. Primary outcomes included wound healing, major amputation, major reintervention, major amputation/death (amputation/death), and major adverse limb events (MALE) or death (MALE/death) and were evaluated using Kaplan-Meier estimates and log-rank tests. RESULTS: Of 1946 limbs undergoing a first-time intervention for CLTI between 2005 and 2022, 765 underwent BPG and 1181 underwent PTA/S. After matching, 862 fit Cohort 1 (431 BPG and 431 PTA/S), and 274 fit Cohort 2 (137 BPG and 137 PTA/S). Both cohorts exhibited a median follow-up of 2.7 years. In Cohort 1, major reintervention and MALE/death were both noted to be significantly lower following ssGSV BPG, as compared with PTA/S (at 7 years: 11% vs 24%
P = .001 and 72% vs 78%
P = .03, respectively). These findings correlated with a 53% and 28% reduction in the aforementioned adjusted events (hazard ratio, 0.47
95% confidence interval, 0.30-0.74 and hazard ratio, 0.82
95% confidence interval, 0.69-0.98, respectively). These significant differences in major reintervention and MALE/death were not noted in Cohort 2 (at 7 years: 25% vs 24%
P = .92 and 82% vs 80%
P = .31, respectively). Further, neither cohort demonstrated significant differences in complete wound healing (at 6 months, Cohort 1: 47% vs 40%
P = .32
Cohort 2: 40% vs 38%
P = .12), major amputation (at 7 years: Cohort 1: 15% vs 15%
P = .89
Cohort 2: 35% vs 25%
P = .86), or amputation/death (at 7 years, Cohort 1: 70% vs 66%
P = .99
Cohort 2: 78% vs 76%
P = .45). CONCLUSIONS: Patients undergoing revascularization using ssGSV demonstrate significantly lower rates of major reintervention and MALE/death compared with those undergoing endovascular interventions for CLTI. However, similar outcomes are not seen among patients undergoing revascularization without a suitable ssGSV. These findings correlate with those demonstrated in BEST-CLI, suggesting generalizability.