Percutaneous transmural arterial bypass in routine practice: Our 2-year experience

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Arterial Bypass Procedures

Background:

• Percutaneous transmural arterial bypass (PTAB) combines open surgical bypass principles with endovascular techniques.
• It is used to treat long-segment occlusions in the superficial femoral (SFA) and popliteal arteries.
• Previous trials like DETOUR1 and DETOUR II reported favorable patency rates, but real-world outcomes are less understood.

Purpose of the Study:

• To evaluate the outcomes of PTAB procedures performed within a specific healthcare system.
• To assess primary (PPR), primary-assisted (PAPR), and secondary patency rates (SPR) outside of controlled clinical trial settings.
• To compare real-world PTAB outcomes with those reported in the DETOUR trials.

Main Methods:

• Retrospective analysis of 49 PTAB procedures in 44 patients from August 2023 to December 2025.
• Data collected included patient demographics, perioperative details, and postoperative outcomes.
• Patency endpoints (PPR, PAPR, SPR) were assessed at multiple time points up to 24 months.

Main Results:

• Technical success was 100%, with a mean SFA occlusion length of 303 mm.
• 12-month patency rates were lower than DETOUR trials: PPR 47.6%, PAPR 71.4%, SPR 90.5%.
• Significant decline in patency observed after 12 months, with 16 stent occlusions and 20 reinterventions.

Conclusions:

• Real-world PTAB outcomes demonstrated lower PPR and PAPR compared to the DETOUR trials.
• Findings highlight the critical need for vigilant post-procedural surveillance.
• Timely reintervention is essential for managing patients undergoing PTAB.