Bypass selection criteria and conduit choice informed by contemporary RCTs
Applied
Type
AdditionConfidence
85%
Created
Mar 19, 2026
Evidence
2 sources
Rationale
The section was expanded to incorporate the latest 2025 ACC scientific statement regarding diabetic patients, who represent a significant portion of the CLTI population and require specific revascularization considerations. Additionally, evidence regarding the value of accurate imaging in the decision-making process was integrated to emphasize the importance of proper staging (GLASS) and conduit evaluation before selecting a surgical or endovascular approach.
Evidence
Content Changes
removedadded
In patients with chronic limb-threatening ischemia (CLTI), the selection between a bypass-first versusand an endovascular-first strategy selection depends on the availability of an adequate autologous vein availability,conduit, anatomic complexity (GLASSas staging),defined by the Global Anatomic Staging System (GLASS), and patient surgical fitness. For patients with diabetes, management strategies must account for the high prevalence of infrapopliteal disease and increased wound complications [@acc2025-g]. Accurate preoperative imaging is essential to ensure appropriate staging and conduit assessment, as misallocation of imaging resources can lead to suboptimal revascularization choices [@raskin2025-b]. For BEST-critical limb ischemia (CLI) and BASIL trial evidence, conduit selection criteria, and revascularization algorithm, see [[Peripheral Artery Disease|Ch. 10]].