An 80-year-old male with diabetes and a previous right leg amputation was concerned about amputation of his left foot due to chronic ulcer and reduced blood flow. He was considering femoral popliteal bypass surgery versus stents. A randomized controlled trial compared amputation rates of endovascular stents versus bypass surgery in patients with critical limb ischemia. The trial found no significant difference in amputation-free survival or health-related quality of life between the two groups after 6 months. However, the surgery-first strategy was approximately one-third more costly than the angioplasty-first strategy in the first year.

1.  Student ID: 2022810007
 Name: Muhammad Naveed Khan
 Submitted To: LIU Qin Laoshi

2. • A 80 years old male with diabetes for 20 years
• s/p right Below knee amputation 3 years ago
• Left foot chronic ulcer, Ankle brachial index: 0.6,
angio: femoral a. stenosis
• Afraid of amputation !!!
• Femoral popliteal bypass surgery VS stents

3.  P - Patients with limb ischemia
 I - Stents
 C - Bypass surgery
 O - Amputation rate
 T - RCT

4.  :In patients with critical limb ischemia, is the
amputation rate of endovascular stent less than
of bypass surgery?

5.  Treatment of chronic critical limb ischemia
1. Percutaneous transluminal angioplasty
2. Bypass surgery
3. Thrombolytic therapy
 Aortoiliac vs infrainguinal disease

6.  P Patients with limb ischemia
 I Angioplasty
 C Bypass surgery
 O Amputation rate
 Type: Therapy
 Level of evidence
Level 1-RCT Level 2-Cohort Level 3-Case-control Level 4-Case series

7.  Keywords
(limb ischemia) AND bypass AND angioplasty AND amputation
 Results: 454

8.  Keywords
(limb ischemia) AND bypass AND angioplasty AND
amputation*[MeSH]
 Limits
Humans, Clinical Trial, Meta-analysis, Randomized Controlled Trial
 Results: 23

12.  Multicentric randomized trial
surgery-first (n=228) or
angioplasty-first (n=224)
strategy Infrainguinal disease
 Primary Endpoint:
Amputation-free survival

13.  Trial duration:
5.5 years
 Eight individuals
(1.7%) were lost to follow-up
 Baseline data
 Total n=452
 Angioplasty(n=224)(57%)
 Surgery(n=228)(62%)
 At the end of follow-up,
248 (55%) patients were alive without amputation,
38 (8%) alive with amputation,
36 (8%) dead after amputation,
130 (29%) dead without amputation.

14.  After 6 months, no significant difference in
amputation-free survival
(48 vs 60 p’t; hazard ratio: 0.73; 95% CI: 0.49-1.07)
 No difference in health- related quality of life
 One third higher hospital costs in surgery-first
strategy for the first year

15.  Are patients assigned randomly? YES
 Is the method of assignment confidential? YES
 Is the tracking complete? YES
 Are the treatments blinded to the patient, the medical
staff, or not? NO
 Are the treatments the same other than the study
treatment program? YES
 Was the baseline at the start of treatment similar? YES

17.  Angioplasty = Stents ? : YES
 According to the Paper:
outcome similar but surgery more cost and chances of
secondary disease as compare to angioplasty which has
lower cost.
 Can we perform the treatment in the literature:
Yes