Strategy-based revascularization for complex femoropopliteal disease: endovascular-first versus surgical bypass in
1Department of Cardiovascular Surgery, Trabzon Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Türkiye.
Insights
Surgical bypass (BP) offers superior mid-term primary patency for complex femoropopliteal (FP) artery disease compared to endovascular treatment (EVT). Limb outcomes were similar between the two treatment strategies.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Therapies
Background:
- Complex femoropopliteal (FP) artery disease poses significant challenges in limb salvage and maintenance of arterial patency.
- Endovascular treatment (EVT) and surgical bypass (BP) are primary revascularization strategies, each with distinct advantages and limitations.
Purpose of the Study:
- To compare the efficacy and safety of EVT versus BP in managing complex FP artery disease.
- To evaluate primary patency rates and secondary clinical outcomes between the two treatment modalities.
Main Methods:
- Retrospective single-centre cohort study of 168 patients with Trans-Atlantic Inter-Society Consensus (TASC II) C-D FP lesions (2018-2023).
- Patients were stratified into EVT (n=98) and BP (n=70) groups.
- Primary outcome: primary patency at 12 and 24 months. Secondary outcomes: target lesion revascularization, amputation-free survival, major amputation, and complications.
Main Results:
- The BP group had longer lesions and more chronic total occlusions.
- Primary patency was significantly higher in the BP group at 12 months (86.9% vs 71.4%) and 24 months (78.1% vs 58.2%).
- BP was independently associated with a reduced risk of primary patency loss (HR=0.58). Limb-related outcomes, including major amputation, were comparable.
Conclusions:
- Surgical bypass demonstrates superior mid-term primary patency for complex FP disease compared to EVT.
- Both EVT and BP offer comparable limb salvage rates in this patient cohort.
- Treatment strategy selection should consider lesion complexity and desired patency outcomes.
Aim:
To compare the outcomes of endovascular treatment (EVT) and surgical bypass (BP) for the management of complex femoropopliteal (FP) artery disease.
Methods:
This retrospective single-centre cohort study included patients with Trans-Atlantic Inter-Society Consensus (TASC II) C-D lesions in the FP segment treated between 2018 and 2023. The patients were categorized into two groups according to treatment strategy: EVT and surgical BP. The primary outcome was primary patency at 12 and 24 months. Secondary outcomes included target lesion revascularization, amputation-free survival, major amputation, and procedural complications.
Results:
A total of 168 patients were included, with 98 patients in the EVT group and 70 patients in the BP group. Patients in the BP group had significantly longer lesion lengths and a higher prevalence of chronic total occlusions. Kaplan-Meier analysis demonstrated significantly higher primary patency in the BP group compared with the EVT group at 12 months (86.9% vs 71.4%, log-rank p=0.018) and 24 months (78.1% vs 58.2%, log-rank p=0.009). Target lesion revascularization occurred in 7 patients (7.1%) in the EVT group and 4 patients (5.7%) in the BP group (RR=1.25; 95% CI 0.38-4.07). Major amputation occurred in 9 patients (9.2%) in the EVT group and 7 patients (10.0%) in the BP group (RR=0.92; 95% CI 0.36-2.35). In multivariable analysis, BP was independently associated with reduced risk of primary patency loss (HR=0.58; 95% CI 0.35-0.94; p = 0.028).
Conclusion:
In patients with complex FP disease, BP was associated with higher mid-term primary patency compared with EVT, while limb-related outcomes remained comparable between strategies.
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