Viabahn stent graft compared with prosthetic surgical above-knee bypass in treatment of superficial femoral artery disease

Abstract

The prosthetic surgical above-knee bypass (pAKB) is a standard therapy in superficial femoral artery (SFA) occlusive disease in absence of suitable vein. Viabahn graft has been established as a promising alternative. Since limited comparative data are available, we conducted a retrospective study to compare long-term outcomes of these 2 therapies in a real-world setting.Records of 52 patients (60 limbs), who were treated by pAKB (29 limbs) or Viabahn (31 limbs) were reviewed. Patients were followed up by clinical assessment, physical examination, and resting ankle brachial index (ABI) after 3, 6, 12 months and yearly thereafter. Long-term data were available for 97% in the Viabahn and 93% for pAKB after 73 ± 3.7 months (mean ± standard error [SE]).Long-term primary and secondary patencies in Viabahn group were 40% and 70%, respectively, after 63 ± 2.8 months (mean ± SE). Total lesion length was 19 ± 11.06 cm (mean ± SE), graft size was 6 ± 0.72 mm (mean ± SE). Hospital stay was 4.8 ± 0.72 days (mean ± SE). Limb salvage was achieved in 90%. Patients in the pAKB group showed a total lesion length of 24.39 ± 1.97 cm (mean ± SE), graft size was 7 ± 0.99 mm (mean ± SE). Long-term analysis after 83 ± 6.8 months (mean ± SE) revealed a primary patency of 78% with a secondary patency of 94%. Hospital stay was 10.4 ± 1.27 days (mean ± SE). Limb salvage was ensured in 97%. Long-term primary patency was lower for Viabahn (P = .044), secondary patency (P = .245), and leg salvage (P = .389) were not significantly different. However, hospital stay was shorter (P = .0002) for Viabahn.Long-term analysis of Viabahn revealed a significantly lower primary patency, a similar secondary patency, limb salvage, and significantly shorter hospital stay when compared with pAKB. Our data suggest that pAKB is still a valuable option in patients suitable for an open operation. However, Viabahn can be used as a less invasive treatment in high risk patients.

Revascularization Strategies for Patients With Femoropopliteal Peripheral Artery Disease

“…Data from observational studies indicate a higher rate of technical success with the use of alternative access such as distal superficial femoral has an impact on MALE; however, these were observational studies with limited ability to derive definitive conclusions. 28 In keeping with previous findings, 16,21,29 Furthermore, the inclusion and exclusion criteria of individual trials differed slightly. Such differences were accounted for by adjusting outcomes for differences for these factors.…”

“…Whereas the individual randomized controlled trials were too small to derive definitive conclusions on the effect of the different treatment strategies on these clinical endpoints, observational studies with larger sample sizes have shown mixed results. 17,[18][19][20][21][22][23] To date, this analysis is the most robust evidence on the comparison of EVT with stent implantation vs BSx for these clinical endpoints.…”