Zlatanovic, Petar (57201473730)Petar (57201473730)ZlatanovicMahmoud, Amr A. (57730710900)Amr A. (57730710900)MahmoudCinara, Ilijas (6602522444)Ilijas (6602522444)CinaraCvetic, Vladimir (57189236266)Vladimir (57189236266)CveticLukic, Borivoje (57189238643)Borivoje (57189238643)LukicDavidovic, Lazar (7006821504)Lazar (7006821504)Davidovic2025-06-122025-06-122021https://doi.org/10.1016/j.ejvs.2020.11.009https://www.scopus.com/inward/record.uri?eid=2-s2.0-85097675606&doi=10.1016%2fj.ejvs.2020.11.009&partnerID=40&md5=c40b91f1c6d9f16195339a464aec3283https://remedy.med.bg.ac.rs/handle/123456789/4351Objective: There are currently two treatments available for patients with chronic limb threatening ischaemia (CLTI): open surgical bypass (OSB) and percutaneous transluminal angioplasty with/without stenting (PTA/S). The aim of this study was to compare short and long term outcomes between PTA/S and OSB in CLTI patients with long (GLASS grade III and IV) femoropopliteal disease. Methods: This was a two centre retrospective study including all consecutive patients with CLTI undergoing first time lower extremity intervention at two distinct vascular surgical centres. Between 1 January 2012 and 1 January 2018, 1 545 CLTI consecutive limbs were treated for femoropopliteal GLASS grade III and IV lesions at two vascular surgical centres. Using covariables from baseline and angiographic characteristics, a propensity score was calculated for each limb. Thus, comparable patient cohorts (235 in PTA/S and 235 in OSB group) were identified for further analysis. The primary outcomes were freedom from re-intervention in the treated extremity and major amputation. Secondary outcomes were all hospital complications among the two patient groups. Results: Total overall complication rates were significantly higher in the OSB group (20.42% vs. 5.96%, p <.001), especially wound infection/seroma rate that required prolonged hospitalisation and further treatment (7.65% vs. 0%, p <.001). After the median follow up of 61 months, re-intervention rates were significantly higher in the PTA/S group (log rank test, 44.68% vs. 29.79%, p =.002), but there was no significant difference in terms of major amputation rates between the two group of patients (log rank test, PTA/S 27.23% vs. OSB 22.13%, p =.17). Conclusion: Bypass surgery seems to be superior to PTA/S for GLASS grade III and IV femoropopliteal lesions in patients with CLTI in terms of long term re-intervention rates, but with considerably higher rates of post-operative complications. A larger cohort of patients in currently ongoing randomised trials, as well as prospective cohort studies are necessary to confirm these findings. © 2020 European Society for Vascular SurgeryBypass surgeryChronic limb threatening ischaemia (CLTI)Endovascular treatmentFemoropopliteal lesionGLASS grade III/IVShort and long term outcomes