Femoro-popliteal bypass versus remote endarterectomy: a propensity matched analysis

Area of Science:

• Vascular Surgery
• Endovascular Procedures
• Surgical Outcomes Analysis

Background:

• Long femoropopliteal occlusions present a significant challenge in peripheral artery disease treatment.
• Femoropopliteal bypass (FPB) and remote endarterectomy (RE) are surgical options for these complex lesions.

Purpose of the Study:

• To compare the effectiveness of femoropopliteal bypass (FPB) versus remote endarterectomy (RE) for treating long femoropopliteal lesions.
• To evaluate outcomes including primary and secondary patency, and target lesion revascularization.

Main Methods:

• Retrospective analysis of symptomatic patients with femoro-popliteal segment occlusions (>250 mm) from 2014-2020.
• Propensity score matching was used to compare patients undergoing FPB (above the knee) with those undergoing RE.
• Primary endpoints included primary patency (PP), secondary patency (SP), and target lesion revascularization (TLR).

Main Results:

• Three-year primary patency rates were 62% for FPB vs. 53% for RE (P=0.16).
• Secondary patency rates were 84% for FPB vs. 75% for RE (P=0.10).
• Great saphenous vein (GSV) bypass and RE showed statistically significant advantages over PTFE bypass in SP, TLR, and amputation-free survival (AFS).

Conclusions:

• Surgical treatment using autovenous bypass (GSV) or RE demonstrated superior secondary patency, TLR, and AFS compared to PTFE prostheses.
• GSV bypass remains the preferred method for femoropopliteal bypass surgery due to its favorable outcomes.