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Vein Interposition Model: A Suitable Model to Study Bypass Graft Patency
Published on: January 15, 2017
Endovascular Transvenous versus Open Femoropopliteal Bypass
Roberts Rumba1, Dainis Krievins1, Natalija Ezite2
1Vascular Surgery Department, Pauls Stradins Clinical University Hospital, 1002 Riga, Latvia.
Insights
Saphenous vein bypass offers superior primary patency for superficial femoral artery lesions compared to transvenous endovascular methods. While transvenous bypass is viable, prosthetic grafts show the lowest patency rates, indicating limited use.
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.
Abstract:
Background and Objectives: Lower extremity arterial disease is one of the most prevalent manifestations of atherosclerosis. The results from numerous studies regarding the best revascularization method of an occluded superficial femoral artery have been conflicting. The aim of this study was to compare the patency of transvenous endovascular with open femoropopliteal bypass, both with vein and prosthetic grafts. To our knowledge, a direct patency comparison between transvenous endovascular and open femoropopliteal bypass has not been published. This could help elucidate which method is preferable and in which cases. Materials and Methods: Patients with complex TASC-C and D SFA lesions were offered endovascular transvenous or open bypass. A total of 384 consecutive patients with PAD requiring surgical treatment were evaluated for inclusion in this study. Three-year follow-up data were collected for 52 endovascular procedures, 80 prosthetic grafts, and 44 venous bypass surgeries. Bypass patency was investigated by Duplex US every 6 months. Kaplan-Meier plots were used to analyze primary, primary-assisted, and secondary patency for endovascular transvenous, autovenous, and prosthetic bypasses. Results: Primary, primary-assisted, and secondary patency in venous group at 3 years was 70.5%, 77.3%, and 77.3%, respectively. In the endovascular transvenous group, primary, primary-assisted, and secondary patency at 3 years was 46.2%, 69.2%, and 76.9%, respectively. The lowest patency rates at 3 years were noted in the prosthetic graft group with 22.5% primary, 26.6% primary-assisted, and 28.2% secondary patency. Conclusions: The saphenous vein is the best graft to perform in above-the-knee femoropopliteal bypass. Transvenous endovascular bypass is a viable option with comparable primary-assisted and secondary patency. Primary patency is substantially lower for endovascular transvenous compared to venous bypass. Patients treated with endovascular transvenous bypass will require a significant number of secondary procedures to provide optimal patency. Prosthetic grafts should only be used if no other option for bypass is available.
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