Endovascular Transvenous versus Open Femoropopliteal Bypass

Area of Science:

• Vascular Surgery
• Endovascular Therapy
• Atherosclerosis Research

Background:

• Lower extremity arterial disease is a common manifestation of atherosclerosis.
• Optimal revascularization strategies for superficial femoral artery occlusions remain debated.
• Direct comparisons of transvenous endovascular and open femoropopliteal bypass patency are limited.

Purpose of the Study:

• To compare the patency rates of transvenous endovascular bypass versus open femoropopliteal bypass (vein and prosthetic grafts).
• To evaluate the long-term efficacy of different revascularization methods for complex superficial femoral artery lesions.
• To provide evidence-based guidance on selecting the most appropriate treatment strategy.

Main Methods:

• Prospective study comparing transvenous endovascular bypass, autovenous bypass, and prosthetic grafts in patients with TASC-C and D superficial femoral artery lesions.
• Three-year follow-up data collected for 52 endovascular, 80 prosthetic, and 44 venous bypass procedures.
• Bypass patency assessed via Duplex ultrasound every six months; Kaplan-Meier analysis used for patency rates.

Main Results:

• Three-year secondary patency rates: Venous bypass (77.3%), Endovascular transvenous (76.9%), Prosthetic graft (28.2%).
• Primary patency rates at 3 years: Venous bypass (70.5%), Endovascular transvenous (46.2%), Prosthetic graft (22.5%).
• Endovascular transvenous bypass demonstrated comparable primary-assisted and secondary patency to venous bypass but significantly lower primary patency.

Conclusions:

• Autovenous saphenous vein grafts are the preferred option for above-knee femoropopliteal bypass due to superior primary patency.
• Transvenous endovascular bypass is a feasible alternative with good assisted and secondary patency, though requiring more interventions.
• Prosthetic grafts are associated with significantly lower patency and should be reserved for cases where no other bypass options exist.