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How to compare results from open with endovascular procedures?
Marc Bosiers1, Koen Deloose2, Joren Callaert2
1Department of Vascular Surgery, A.Z. Sint-Blasius Hospital, Dendermonde, Belgium - marc.bosiers@telenet.be.
The Journal of Cardiovascular Surgery
|May 11, 2018
Summary
Surgical bypass patency for femoropopliteal lesions is overestimated compared to endovascular criteria. Applying stricter endovascular definitions reveals lower primary patency rates, suggesting comparable outcomes between bypass and modern endovascular treatments.
Area of Science:
- Vascular Surgery
- Endovascular Therapy
- Vascular Imaging
Background:
- Femoropopliteal TASC C and D lesions often require bypass surgery, the current gold standard.
- Endovascular therapy has advanced but direct comparison with surgery is challenging.
- Discrepancies in patency definitions (surgical vs. endovascular) affect outcome interpretation.
Purpose of the Study:
- To evaluate the impact of endovascular criteria on the assessment of femoropopliteal bypass patency.
- To compare primary patency rates of bypass grafts using surgical versus endovascular definitions.
Main Methods:
- A cohort of 100 patients with surgically patent femoropopliteal bypasses was studied.
- Duplex ultrasonography was used to measure Peak Systolic Velocity Ratio (PSVR) at anastomoses.
Main Results:
- Out of 100 bypasses deemed patent by surgical standards, 11 showed a PSVR ≥2.4.
- This indicates a significant proportion of surgically patent bypasses may not meet stricter criteria.
Conclusions:
- Surgical primary patency of 78% decreased to approximately 70% when using endovascular criteria.
- Modern endovascular treatments for complex femoropopliteal lesions may offer comparable primary patency to above-knee bypasses.
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