Regarding “Stent grafts vs femoropopliteal bypass”

Abstract

The randomized controlled trial (RCT) by Kedora et al 1 showed that management of femoropopliteal (FP) arterial occlusive disease using percutaneous treatment with an expanded polytetrafluoroethylene (PTFE)/nitinol self-expanding stent graft was comparable to surgical revascularization with conventional above knee (AK)-FP bypass using synthetic material up to 12 months. In the surgical bypass group, Dacron grafts were used in 64%, and expanded PTFE was used in 36%. We would like to suggest, however, that saphenous vein (SV) grafts should be used instead of synthetic material as conduit of the FP bypass in the control group because of the following reasons. According to the meta-analysis of uncontrolled series by Pereira et al, 2 SV grafts performed better than PTFE grafts in AK-FP bypass. When only RCTs in the systematic review of AK-FP bypass by Klinkert et al 3 were considered, the patency of SV grafts was better than for PTFE grafts. The most recent meta-analysis by us 4 of currently available five RCTs also demonstrated that SV grafts were superior to PTFE grafts in AK-FP bypass: the pooled primary graft patency of SV and PTFE grafts were 86.6% and 83.7% (P ϭ .3957) at 1 year, 82.6% and 74.6% (P ϭ .0198) at 2 years, 79.2% and 65.3% (P ϭ .0011) at 3 years, 77.6% and 61.3% (P Ͻ .0001) at 4 years, and 76.4% and 56.1% (P Ͻ .0001) at 5 years, respectively. Because the type of prosthetic (Dacron or PTFE) used for AK-FP bypass, grafts did not affect 5-year patency rates in the RCT by Green et al, 5 SV grafts probably surpass both Dacron and PTFE grafts in patency of AK-FP bypass. Therefore, to compare the efficacy of the stent graft vs open surgical AK-FP bypass, conduit of the bypass would be SV rather than Dacron or PTFE. If a stent graft is not superior to, but comparable to AK-FP bypass using synthetic material, it might be inferior to the bypass using SV grafts.

Perkutane koronare Intervention bei Stenosen und Verschlüssen in aortokoronaren Venenbypässen - Wertigkeit der zusätzlichen lokalen Thrombolyse im Vergleich zur alleinigen Ballondilatation mit Stent

“…Operationsmethoden ohne extrakorporale Zirkulation haben die Erwartungen teilweise nicht erfüllt [Lim et al 2006, Takagi et al 2007. Es konnte kein Vorteil bezüglich der Mortalität oder Komplikationen verzeichnet werden.…”