Comparison of Prosthetic and Vein Bypass with Nitinol Stents in Long Femoropopliteal Lesions

Kluckner, Michaela; Gratl, Alexandra; Wipper, Sabine; Hitzl, Wolfgang; Nierlich, Patrick; Aspalter, Manuela; Linni, Klaus; Enzmann, Florian

doi:10.1016/j.avsg.2021.05.052

Cited by 5 publications

(3 citation statements)

References 25 publications

(41 reference statements)

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“…In this study, EVT and bypass surgery showed no differences in amputation-free survival or major adverse limb events after two years, but primary patency was significantly worse after EVT [2]. The previously published 2-year data of the current patient cohort showed no significant differences in patency rates between the NS, PTFE, and VBP groups [9]. However, after four years, the VBP group had significantly better primary assisted and secondary patency rates compared to the results after PTFE and NS, which were almost identical.…”

Section: Discussioncontrasting

confidence: 41%

“…Our group previously reported similar 2-year patency rates from pooled data from a RCT and a retrospective cohort of polytetrafluorethylene bypass (PTFE), vein bypass, and angioplasty with nitinol stents (NS) for the treatment of femoropopliteal Trans-Atlantic Inter-Society Consensus (TASC II) type C and D lesions [8,9]. The aim of this study was to compare the outcomes of the PTFE, VBP, and NS groups at four years.…”

Section: Introductionmentioning

confidence: 94%

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Long-Term Outcome of Bypass Surgery versus Endovascular Revascularization in Long Femoropopliteal Lesions

Kluckner

Grüber

Wippel

et al. 2023

JCM

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Long-term follow-up data comparing surgical and endovascular revascularization of femoropopliteal lesions is rarely reported. This study presents 4-year results of revascularization for long femoropopliteal lesions (Trans-Atlantic Inter-Society Consensus Types C and D) with vein bypass (VBP), polytetrafluorethylene bypass (PTFE), and endovascular intervention with a nitinol stent (NS). Data from a randomized-controlled trial on VBP and NS was compared with a retrospective patient cohort using PTFE with the same inclusion and exclusion criteria. Primary, primary assisted, and secondary patency, as well as changes in Rutherford categories and limb salvage rates, are reported. Between 2016 and 2020, 332 femoropopliteal lesions underwent revascularization. The lesion lengths and basic patient characteristics were similar between the groups. 49% of the patients presented with chronic limb threatening ischemia at the time of revascularization. During the four-year follow-up, primary patency was comparable for all three groups. Primary assisted and secondary patency were significantly higher after VBP, while PTFE and NS had similar results. Clinical improvement was also significantly superior after VBP. After four years of follow-up, patency rates as well as the clinical outcome clearly favor VBP. If no vein is available, NS is as effective as PTFE bypass with regard to patency and clinical outcome.

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Section: Discussioncontrasting

confidence: 41%

Section: Introductionmentioning

confidence: 94%

Long-Term Outcome of Bypass Surgery versus Endovascular Revascularization in Long Femoropopliteal Lesions

Kluckner

Grüber

Wippel

et al. 2023

JCM

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“…In contrast, in the BASIL II trial, endovascular procedures were reported to provide better performance than vein bypasses in the infrapopliteal arteries [ 28 ]. Few studies have directly compared endovascular and prosthetic graft revascularisations in long femoro-popliteal lesions and reported similar results for the endovascular approach and the use of an ePTFE conduit [ 29 ]. In contrast, in our series, using the open approach showed no advantages over using the endovascular approach, as the overall long-term outcomes were worse in the open group than those in the endovascular group.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Revascularisation versus Open Surgery with Prosthetic Bypass for Femoro-Popliteal Lesions in Patients with Peripheral Arterial Disease

Zenunaj,

Acciarri,

Baldazzi

et al. 2023

JCM

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Aim: Complex atherosclerotic femoro-popliteal lesions have traditionally been treated with bypass surgery. A prosthetic graft is used to save the vein graft for more distal revascularisations or when a vein graft is unavailable. The endovascular approach has gained popularity and is offered as a first-line strategy for complex lesions. This study aimed to evaluate whether endovascular procedures can be used as a first-line treatment strategy for complex native femoro-popliteal lesions over open surgery with prosthetic bypass in patients with peripheral arterial disease (PAD). Methods: This single-centre retrospective observational study was conducted between 2013 and 2021; it included patients with symptomatic PAD who required limb revascularisation at the femoro-popliteal segment and who had complex lesions. The primary endpoints analysed were technical success, primary patency, freedom from clinically driven target lesion revascularisation (cdTLR), freedom from major adverse limb and cardiovascular events (MALE and MACE, respectively), freedom from limb loss, and survival. The secondary endpoints were length of in-hospital stay, and duration and costs of the procedure. Results: We identified 185 limbs among 174 suitable candidates for comparison, wherein 105 were treated with an endovascular procedure and 80 with a femoro-popliteal prosthetic bypass. Most patients in both groups presented with chronic limb-threatening ischaemia, and >90% of them had an American Society of Anesthesiologists (ASA) physical status classification of >3. The endovascular group had more octogenarians (p = 0.02) and patients with coronary disease (p = 0.004). The median follow-up was 30 months. The technical failure rate for endovascular procedures was 4.7%, versus 0% in the open group (p = 0.047). Freedom from MACE was similar in both groups. The endovascular group showed superior primary patency (p < 0.0001), cdTLR (p < 0.0001), MALE (p < 0.0001), and freedom from limb loss (p = 0.0018) at 24 and 48 months. Further analysis performed for the open above-the-knee sub-group showed that the aforementioned endpoints were similar between the groups at 12 months and were better in the endovascular group at 24 and 48 months. Procedural time and in-hospital stay were longer in the open group than in the endovascular group (p < 0.0001 and p < 0.001, respectively). The procedural cost in the endovascular group was 10-fold lower than that in the prosthetic bypass group. Conclusions: Endovascular procedures are safe for treating complex femoro-popliteal lesions in patients at a high risk for surgery and show better outcomes at 24 months than prosthetic bypasses do. The latter may be considered as an alternative should endovascular treatment fail.

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2022

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Comparison of Prosthetic and Vein Bypass with Nitinol Stents in Long Femoropopliteal Lesions

Cited by 5 publications

References 25 publications

Long-Term Outcome of Bypass Surgery versus Endovascular Revascularization in Long Femoropopliteal Lesions

Long-Term Outcome of Bypass Surgery versus Endovascular Revascularization in Long Femoropopliteal Lesions

Endovascular Revascularisation versus Open Surgery with Prosthetic Bypass for Femoro-Popliteal Lesions in Patients with Peripheral Arterial Disease

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