Individual research recommendation details

Recommendation ID

CG147/1

Question

Angioplasty versus bypass surgery for treating people with critical limb ischaemia caused by disease of the infra-geniculate arteries:- What is the clinical and cost effectiveness of a 'bypass surgery first' strategy compared with an 'angioplasty first' strategy for treating people with critical limb ischaemia caused by disease of the infra-geniculate (below the knee) arteries?

Any explanatory notes
(if applicable)

Why this is important:- Many people with critical limb ischaemia, especially those with diabetic vascular disease, also have disease of the infra-geniculate (below the knee) arteries in the calf. For many years, the standard of care has been bypass surgery. Although such surgery may be associated with significant morbidity, the resulting long-term amputation-free survival rates are generally good. In recent years there has been a trend towards treating infra-geniculate disease with angioplasty, on the grounds that it is associated with less morbidity than surgery. However, this change in practice is not evidence-based, and serious concerns remain about the durability of angioplasty in this anatomical area. A multicentre, randomised controlled trial with a full health economic analysis is required to address this. The primary endpoint should be amputation-free survival, with secondary endpoints including overall survival, health-related quality of life, healing of tissue loss, and relief of ischaemic pain.

Source guidance details

Comes from guidance

Peripheral arterial disease: diagnosis and management

Number

CG147

Date issued

August 2012

Other details