Long-term results of open and endovascular revascularization of superficial femoral artery occlusive disease

Abstract

Background First-line treatment for patients with superficial femoral arterial (SFA) occlusive disease has yet to be determined. This study compared long-term outcomes between primary SFA stent placement and primary femoral-popliteal bypass. Periprocedural patient factors were examined to determine their effect on these results. Methods All femoral-popliteal bypasses and SFA interventions performed in consecutive patients with symptoms Rutherford 3 to 6 between 2001 and 2008 were reviewed. Time-dependent outcomes were analyzed using the Kaplan-Meier method and log-rank test. Cox proportional hazards were performed to determine predictors of graft patency. Multivariate analysis was completed to identify patient covariates most often associated with the primary therapy. Results A total of 152 limbs in 141 patients (66% male; mean age, 66 ± 22 years) underwent femoral-popliteal bypass, and 233 limbs in 204 patients (49% male; mean age, 70 ± 11 years) underwent SFA interventions. Four-year primary, primary-assisted, and secondary patency rates were 69%, 78%, and 83%, respectively, for bypass patients and 66%, 91%, and 95%, respectively, for SFA interventions. Six-year limb salvage was 80% for bypass vs 92% for stenting (P = .04). Critical limb ischemia (CLI) and renal insufficiency were predictors of bypass failure. Claudication was a predictor of success for SFA stenting. Three-year limb salvage rates for CLI patients undergoing surgery and SFA stenting were 83%. Amputation-free survival at 3 years for CLI patients was 55% for bypass and 59% for SFA interventions. Multivariate predictors (odds ratios and 95% confidence intervals) of covariates most frequently associated with first-line SFA stenting were TransAtlantic Inter-Society Consensus II A and B lesions (5.9 [3.4-9.1], P < .001), age >70 years (2.1 [1.4-3.1], P< .001), and claudication (1.7 [1.1-2.7], P= .01). Regarding bypass as first-line therapy, claudicant patients were more likely to have nondiabetic status (5.6 [3.3-9.4], P < .001), creatinine <1.8 mg/dL (4.6 [1.5-14.9], P = .01), age <70 years (2.7 [CI, 1.6-8.3], P < .001), and presence of an above-knee popliteal artery target vessel (1.9 [CI, 1.1-3.4] P = .02). Conclusion Indication, patient-specific covariates, and anatomic lesion classification have significant association when determining surgeon selection of SFA stenting or femoral-popliteal bypass as first-line therapy. Patients with SFA disease can have comparable long-term results when treatment options are well matched to patient-specific and anatomic characteristics. (J Vasc Surg 2011;54:714-21.)

Comparison of Long-Term Outcome After Endovascular Therapy Versus Bypass Surgery in Claudication Patients With Trans-Atlantic Inter-Society Consensus-II C and D Femoropopliteal Disease

“…Although EVT has advanced and outcomes have improved, few reports have compared EVT and bypass surgery in claudication patients. 8- 10 In addition, although there are reports examining EVT outcome in patients with intermittent claudication, few studies have compared outcome between EVT and bypass surgery in claudication patients with TASC-II C and D femoropopliteal disease. The present study used data from a multicenter registry in Japan to analyze the outcomes of he best way to manage peripheral arterial disease (PAD) remains unresolved.…”

Outcomes of endovascular lower extremity interventions depend more on indication than physician specialty

“…8,9 This clearly represents “confounding by indication” 10 and is one of the most important limitations of observational studies leading to a flawed study design and findings. Therefore, it is imperative to control for such factors in predictive models to reduce the potential bias in treatment effect estimates.…”

Comparison between superficial femoral artery stenting and bypass surgery in severe lower-limb ischaemia : a retrospective study : cardiovascular topic

“…There are not many publications comparing femoral artery stenting and bypass surgery, and the assessment of patency and the overall results of different treatment modalities is somewhat problematic, as study designs vary considerably. [16][17][18][19] In our series, 80% of TASC II A and B lesions received stents and 76% of TASC II C and D lesions received bypasses. These figures are in keeping with those reported in previous studies.…”

“…These figures are in keeping with those reported in previous studies. 9,18,19 There is evidence that shorter lesions do well with angioplasty/ stent, while longer lesions have significantly lower patency rates. 9 The latest TASC II recommendations include an endovascular approach for shorter lesions and a bypass for longer lesions.…”