Comparison of above-the-knee prosthetic femoro-popliteal bypass versus percutaneous transluminal angioplasty and stenting for treatment of occlusive superficial femoral artery disease

Abstract

Background and Aims: Treatment of occlusive femoro-popliteal artery disease has changed during the last decade because of intensive development of endovascular technology. The aim of this study was to evaluate patient treated endovascularly or surgically for femoropopliteal atherosclerotic lesions and to assess perioperative and mid-term outcome. Material and Methods: This is a retrospective analysis of consecutive patients who had undergone prosthetic above-the-knee femoro-popliteal bypass or percutaneous transluminal angioplasty and stenting of superficial femoral artery stenosis or occlusion at Tampere university hospital, finland, between January 2007 and december 2009. patients who were alive were re-evaluated in 2010. primary and secondary patency and outcomes were assessed. Results: a total of 131 patients were treated; surgically 63 patients (69 procedures) and endovascularly 68 patients (74 procedures). The mean follow-up time was 17 months (sd ± 13 months). in the late follow-up visit, 8 (18%) patients in the bypass group suffered from claudication and 9 (20%) from critical limb ischemia. The corresponding figures for the endovascular group were 20 (36%) and 8 (20%), respectively. The primary patency was 60% at 2 years in the bypass group and 73% in the endovascular group (p = 0.092); the primary assisted patency was 62% versus 76%, respectively (p = 0.068). The secondary patency was 74% in the bypass group versus 79% in the endovascular group (p = 0.487). Conclusions: according to current results following TasC ii guideline, satisfied overall mid-term results can be achieved in the treatment of superficial femoral artery atherosclerotic disease.

Hybrid Common Femoral Artery Surgical Revascularization Associated to Endovascular Femoropopliteal Recanalization in High-Risk (ASA 3 - 4) Patients: A Seven-Year Period Institutional Experience

“…Our mean length of hospital stay (6.1 days) was shorter than similar bypass reports [20]- [22] [27], yet slightly longer than analogous uncombined endovascular series (acknowledging accepted limits for technical feasibility) [9]- [11]. Otherwise, this observation harmonizes with parallel hybrid series results [20] [27].…”

“…Parallel contemporary studies also emphasize encouraging primary and secondary patency results for SFA angioplasty and stenting [10] [11], even in the presence of long stenosis and occlusions [8] [10]. Additional contemporary experience that follows new advances in femoro-popliteal CTO revascularization evinces comparable results of SFA angioplasty and stenting (Figures 3-5) versus above-the-knee bypass for short and mid-term primary and secondary patency rates [22] [23].…”

Drug-Eluting Stent Shows Similar Patency Results as Prosthetic Bypass in Patients with Femoropopliteal Occlusion in a Randomized Trial

“…8 Comparison of stenting and prosthetic bypass grafting has yielded similar results at 4-year follow-up in an randomized controlled trial with 100 revascularizations and in a smaller, retrospective study. 9,10 Drug-eluting stents (DESs) have proven their worth in coronary artery lesions and to some degree in femoral occlusions. 11 Although early trials failed to show benefit from DES versus bare metal stents, 12,13 subsequent studies have shown improved event-free survival up to 5 years.…”

Percutaneous Femoropopliteal Bypass: 2-Year Results of the DETOUR System

“…Outpatient evaluation found 62% and 50% in Rutherford class 0 for open bypass and EVT groups, respectively. 34 Similar to the midterm follow-up, ABI for the open bypass and EVT groups, consistent ABI normalization through 2 years, was also found to be a hemodynamic benefit. 34 Potential limitations of the DETOUR study include the inability to find a single, fair comparator device, since the DETOUR system is the first of its kind.…”