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Our findings in the EV group are very similar to Conrad et al,12 who reported long-term outcomes after endovascular interventions in CLI patients treated between 2002 and 2007, although 89% of our patients had tissue loss and 81% had TASC C or D lesions with similar distribution of infrapopliteal and multilevel interventions. Our mean follow-up of 28 months is also similar, which enables reporting 5-year outcomes with a reasonable standard error ([http://en.wikipedia.org/wiki/3-mercaptopyruvate_sulfurtransferase 3-mercaptopyruvate sulfurtransferase] interventions for CLI have much shorter follow-up, usually 12 to 14 months.7, 13, 20?and?21 Our overall 5-year LS of 78% in the EV group, 91% in autologous vein bypass group, and 67% in nonautologous graft bypass group are all comparable to the previous reports.22, 23, 24, 25?and?26 Although the best outcomes were observed in the autologous vein graft group, which was independently associated with improved outcomes, the patients selected for this bypass were the fittest who had suitable vein, as evidenced by the 25% better 5-year survival than those who had prosthetic bypass and endovascular revascularization. The most disadvantaged patients in anatomy and overall medical condition were the nonautologous [http://www.selleckchem.com/products/kpt-330.html Selleckchem Selinexor] bypass group, and our aggressive use of endovascular interventions enabled us to progressively decrease this percentage of patients. We found that functional capacity, diabetes, dialysis dependence, presence of gangrene, and need for tibial interventions were independently associated with limb loss, and all of these were previously reported in various combinations.13, 20, 21?and?27 We did not find the TASC D classification and the number of patent runoff vessels was associated with limb loss. There have been number of single-center reports of CLI patients7, 27, 28, 29?and?30 with open or endovascular interventions during the same time period; however, some of these studies had only femoropopliteal interventions, whereas others included all levels, with overall survival varying from 42%27 to 80%28 at 5 years, suggesting that the patient selection and referral patterns vary, thus attempting to make meaningful comparisons [http://www.selleckchem.com/products/rgfp966.html buy RGFP966] between studies and subgroups difficult. Soderstrom et al29 compared only infrapopliteal interventions in CLI patients and found LS, AFS, and survival rates were similar overall, and when only isolated infrapopliteal interventions were compared, angioplasty had better LS than bypass (76% vs 68%; P = .042). Overall, endovascular interventions had similar or better outcomes than bypass, except for the study by Korhonen et al, 30 in which the PTA group had worse LS and freedom from surgical reintervention, even after adjustment for propensity score. Similar to our study, gangrene, diabetes, dialysis dependence, and impaired functional capacity predicted poorer LS in the large study by Taylor et al, 27 who included a similar cohort of patients.