Revascularization Strategies for Patients With Femoropopliteal Peripheral Artery Disease
Serdar Farhan1, Florian K Enzmann2, Patrick Bjorkman3
1The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Journal of the American College of Cardiology
|January 25, 2023
Summary
Endovascular therapy (EVT) and bypass surgery (BSx) show similar major limb event rates for femoropopliteal disease. EVT offers fewer early complications and shorter hospital stays, supporting its use as an alternative treatment.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Peripheral Artery Disease Management
Background:
- Limited comparative data exists for endovascular therapy (EVT) versus bypass surgery (BSx) in symptomatic femoropopliteal peripheral artery disease.
- Adequately powered studies directly comparing major clinical outcomes are lacking.
Purpose of the Study:
- To conduct a pooled analysis of individual patient data from randomized controlled trials comparing EVT with stent implantation versus BSx.
- To evaluate the efficacy and safety of EVT compared to BSx for femoropopliteal disease.
Main Methods:
- Pooled analysis of individual patient data from 5 of 6 available randomized controlled trials.
- Primary endpoint: major adverse limb events (death, major amputation, target limb reintervention).
- Secondary endpoints included amputation-free survival, individual event components, primary patency, and early complications within 30 days.
Main Results:
- No significant difference in major adverse limb events (40.1% EVT vs 36.4% BSx) or amputation-free survival at 2 years.
- Primary patency was lower with EVT (51.2%) compared to BSx (61.3%).
- EVT demonstrated significantly lower early complication rates (6.8% vs 22.6%) and shorter hospital stays (3.1 vs 7.4 days).
Conclusions:
- Endovascular therapy is an effective and safe alternative to bypass surgery for symptomatic femoropopliteal peripheral artery disease.
- EVT offers advantages in reduced early complications and shorter hospitalizations.
- Further research may focus on optimizing long-term patency rates for EVT.
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