Current efficacy of open and endovascular interventions for advanced superficial femoral artery occlusive disease

Abstract

There has been a marked shift in treatment modality for advanced femoro-popliteal disease with a lowering of the symptomatic threshold for intervention over 2 decades, likely spurred by the ease of endoluminal interventions. Although peri-procedural and anatomic outcomes for both procedures are equivalent, it appears that open surgery carries a superior long-term clinical efficacy. This superiority is negatively influenced by poor preoperative ambulation status, high modified Cardiac Risk Score, worse presenting symptoms, the occurrence of major adverse cardiovascular events, poor tibial runoff, the absence of hemodynamic success, and occlusion of the original bypass.

Retrograde Transpopliteal Access Is Safe and Effective—It Should Be Added to the Vascular Surgeon's Portfolio

“…The present study demonstrated superior objective performance goals for MALE and AFS 9 and comparable primary, assisted primary, and secondary patency and limb salvage rates, in keeping with our published reports on antegrade femoral interventions. 2 CE was high and freedom from MALE and AFS were high, reflecting the fact that most of the patients presented with claudication. These data suggest that comparable longer term outcomes can be achieved when the retrograde approach is used.…”

“…Definitions of all outcome parameters have been described elsewhere. 2 Analyses were performed using JMP software version 9.0 (SAS Institute, Cary, NC).…”

“…Patients underwent routine duplex ultrasound follow-up at 1, 3, and every 6 months after their procedure using criteria previously described. 2 During follow-up, angiography was only performed if noninvasive studies suggested restenosis and/or occlusion (positive duplex scan with a drop in ankle-brachial index (ABI) of >0.15 or a drop in toe-brachial index of >0.1) and/or the patient had recurrent symptoms. Median followup was 2.5 years (range, 0e11 years).…”

“…2 Patient-centered outcomes of clinical efficacy (CE; absence of recurrent symptoms, maintenance of ambulation, and absence of major amputation), amputation-free survival (AFS; survival without major amputation), and freedom from major adverse limb events (MALE; above-ankle amputation of the index limb or major reintervention [repeat endoluminal intervention, new bypass graft, and jump and/or interposition graft revision]). 6 …”

“…3e5 We have previously reported an approximate 2% failure rate of recanalization during superficial femoral artery (SFA) interventions and adopted the transpopliteal approach to increase our ability to perform endovascular interventions. 2 The aim of the study was to review the outcomes of SFA interventions using an ultrasound-guided retrograde transpopliteal access approach after failed antegrade recanalization.…”