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Long-Term Outcomes of Femorofemoral Crossover Bypass Versus Endovascular Revascularization in Iliac Artery
Edin Ahmic1,2, Paul Swatek1, Iurii Mykoliuk1
1Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria.
Insights
Endovascular treatment (ET) is preferred for iliac artery occlusions due to shorter recovery and fewer complications, while femorofemoral crossover bypass (FCOB) offers durable outcomes for complex cases.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Technology Assessment
Background:
- Iliac artery occlusions pose significant challenges in peripheral artery disease management.
- Surgical bypass and endovascular techniques are primary treatment modalities.
Purpose of the Study:
- To compare long-term outcomes of femorofemoral crossover bypass (FCOB) versus endovascular treatment (ET) for iliac artery occlusions.
- To evaluate patency, limb salvage, survival, and complication rates for both procedures.
Main Methods:
- Retrospective analysis of 200 patients with iliac artery lesions treated with FCOB (n=82) or ET (n=118).
- Assessment of primary patency, primary assisted patency, secondary patency, limb salvage, and survival rates.
- Evaluation of complications including wound infections, restenosis, and reocclusion over a median follow-up of 4.98 years.
Main Results:
- ET showed higher 3-year primary patency (88% vs. 80%) and comparable secondary patency (98% vs. 97%).
- Both methods achieved 8-year limb salvage (94%), but ET had shorter hospital stays and fewer perioperative complications.
- FCOB had lower restenosis rates (6.1% vs. 20.39%) but higher reocclusion rates (19.5% vs. 6.8%). 8-year survival was 67% for ET and 54% for FCOB.
Conclusions:
- Endovascular treatment is recommended as the first-line approach for iliac artery occlusions due to its minimally invasive nature and reduced complications.
- Femorofemoral crossover bypass remains a crucial option for complex lesions or when ET is contraindicated, providing durable results.
- Optimal treatment selection requires careful consideration of patient-specific factors, including clinical and anatomical characteristics.
Abstract:
Objective: The objective of this study is to compare the long-term outcomes of femorofemoral crossover bypass (FCOB) and endovascular treatment (ET) in managing iliac artery occlusions. Methods: The data of 200 patients with iliac artery lesions who were treated at a single center within 7 years were evaluated retrospectively. Of these, 82 (41%) underwent FCOB, and 118 (59%) received ET. Primary outcomes included patency, limb salvage, and survival rates, while secondary outcomes assessed complications, including wound infections and restenosis. Follow-up was conducted over a median of 4.98 years. Results: Primary patency (PP) rates after 3 years were 80% for FCOB and 88% for ET. Primary assisted patency (PAP) was 95% for FCOB and 93% for ET. Secondary patency (SP) was 97% for FCOB and 98% for ET. Both FCOB and ET achieved comparable long-term outcomes in limb salvage, 94% in both groups at 8 years. ET demonstrated advantages in shorter hospital stays (1.49 ± 2.51 vs. 8.21 ± 9.82 days, p < 0.0001) and lower perioperative complications, including transfusion rates (3.4% vs. 13.4%, p = 0.01226). However, FCOB exhibited lower restenosis rates (6.1% vs. 20.39%, p = 0.00441), despite a higher rate of reocclusion (19.5% vs. 6.8%, p = 0.00800). Survival rates at 8 years were 54% for FCOB and 67% for ET. Conclusions: ET is the preferred first-line approach due to its minimally invasive technique, shorter recovery time, and fewer complications. FCOB remains essential for patients with complex lesions or when ET is not feasible, offering durable long-term outcomes. Appropriate treatment selection should consider both the patient's condition and clinical and anatomical factors to optimize the best possible patient outcomes.
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