LAUSR

problem with this review, of course, is that patients with more extensive arterial disease and more advanced ischemia were more likely treated with bypass surgery and possibly were not even candidates for endovascular intervention. Although patient risk factors were compared, the authors made no effort to match patients according to extent of arterial disease! It is also misleading that the authors compared patients who underwent endovascular treatment in the hospital with patients who underwent arterial bypasses. I wonder how many of the endovascular patients could have had these interventions performed on an outpatient basis. The authors cite the BASIL trial that compared endovascular therapy to open surgery and which demonstrated no superior benefits with endovascular therapy at 2 years. However, the authors cite the “remarkable innovations” in the field of endovascular management since that study that might account for their findings, showing that endovascular intervention is better. The concerning, and misleading, point of this article is that the authors are suggesting to patients and other interventionalists that endovascular treatment is the way to go to treat LE-PAD. Why would anyone go to a vascular surgeon when their heart doctor can take care of the problem as well or better than a vascular surgeon can? Patients need to remember that vascular surgeons can offer both minimally invasive treatment or surgical bypass and do what is in their best interest. Take-home Message: The authors repeatedly say their results are a “real-world” comparison of endovascular management vs surgical bypass for LE-PAD. I am not sure what world these heart doctors are living in.