Percutaneous Extraluminal Arterial Bypass Versus Surgical Arterial Bypass: A Comparative Study in a Porcine Model

To compare the four-week patency and degree of intra-graft stenosis of a percutaneously created extraluminal arterial bypass using a stent graft to a surgically created prosthetic bypass in a porcine carotid artery model.

Seven female Yorkshire swine underwent both percutaneous and surgical carotid artery bypass procedures. Percutaneous bypasses were created using subcutaneously tunneled 6-mm GORE VIABAHN stent grafts, while surgical bypasses were performed on the contralateral side. Animals received dual antiplatelet therapy and were monitored weekly with Doppler ultrasound for four weeks. Graft patency and stenosis were assessed with angiography and explant inspection. Percent stenosis at cranial, mid-graft, and caudal segments were calculated and compared.

Percutaneous bypass creation was technically successful in 6 of 7 pigs (86%); one failure was due to stent graft maldeployment. All successfully placed percutaneous and surgical grafts remained patent at four weeks. Mean angiographic stenosis for percutaneous grafts was 47% (caudal), 20% (mid), and 43% (cranial); versus 34% (caudal, p=0.26), 12% (mid, p=0.69), and 35% (cranial, p=0.42) for surgical grafts after four weeks. Visual inspection demonstrated comparable degrees of intimal hyperplasia (p=1.0). Four seromas occurred adjacent to surgical bypasses, whereas none occurred with percutaneous bypasses (p=0.06).

Percutaneously created extraluminal arterial bypass demonstrated similar short-term patency and intra-graft stenosis compared to surgical bypass, supporting its potential as an alternative revascularization strategy in complex PAD.