Comparison of Bypass and Endovascular Intervention for Popliteal Occlusion with the Involvement of Trifurcation for Critical Limb Ischemia

Abstract

The aim of this study is to analyze the technical aspects and outcomes of the treatment of occlusion of the popliteal artery with the involvement of the trifurcation treated with a bypass (open) and endovascular (endo) approach. Overall, 108 consecutive procedures were enrolled retrospectively. Patients were evaluated in 2 groups: the endo group (65 patients) and the open group (43 patients). Primary outcome were MALE (major adverse limb events), amputation-free survival, and early mortality (until 30days). Secondary outcome was overall survival in 3years. Inclusion criteria were Rutherford 4 and 5 and occlusion of the popliteal artery with the involvement of trifurcation and, at least, 1 infrapopliteal artery of runoff. Technical success was achieved in 100% of patients in the open and 96.9% of patients in the endo group. Freedom from MALE was 73.5% and 68.5% for 1 and 3years respectively for the endo group, and 84.3% and 77.2% respectively for the open group (P=0.413). Considering the total number of major reinterventions executed until 3years, the reinterventions was statistically more performed in the endo compared to the open group (P=0.0459). Amputation-free survival for the endo group in 30days, 1year, and 3years was 93.7%, 79.3%, and 66.0%, respectively, and the amputation-free survival for the open group was 88.4%, 77.4%, and 64.3% (P=0.726). Early mortality was 9.3% for the open group and 1.5% for the endo group (P=0.060). In 3years, the overall survival was 75.1% in the open group and 84.3% in the endo group. In 3years, follow-up endovascular treatment of occlusion of the popliteal artery with the involvement of the trifurcation has similar time freedom from MALE comparedto open approach. Overall and amputation-free survival was not different betweenthe groups besides more reinterventions in patients who underwent endovascular approach.