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

To compare the 4-week patency and degree of intragraft stenosis of a percutaneously created extraluminal arterial bypass using a stent graft with 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 (W. L. Gore & Associates, Flagstaff, Arizona) stent grafts, while surgical bypasses were performed on the contralateral side. Animals received dual antiplatelet therapy and were monitored weekly with Doppler ultrasound (US) for 4 weeks. Graft patency and stenosis were assessed with angiography and explant inspection. Percent stenosis at cranial, midgraft, and caudal segments were calculated and compared.

Percutaneous bypass creation was technically successful in 6 of 7 pigs (86%); 1 failure was due to stent graft maldeployment. All successfully placed percutaneous and surgical grafts remained patent at 4 weeks. Mean angiographic stenosis for percutaneous grafts was 47% (caudal), 20% (mid), and 43% (cranial)-versus 34% (caudal; P = .26), 12% (mid; P = .69), and 35% (cranial; P = .42) for surgical grafts-after 4 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 = .06).

Percutaneously created extraluminal arterial bypass demonstrated similar short-term patency and intragraft stenosis compared with surgical bypass, supporting its potential as an alternative revascularization strategy in complex peripheral artery disease.