Comparison of outcome of various modalities in trans-atlantic inter-society consensus d femoropopliteal disease

Abstract

Background: This study aimed to assess the role of various modalities of treatment for trans-atlantic inter-society consensus document (TASC D) femoropopliteal disease. Methods: This was a retrospective and prospective study from January 2015 to December 2018; 153 patients who were admitted at Army Hospital Research and Referral with TASC D femoropopliteal disease and underwent hybrid procedure, endovascular or open surgery were included in the study. Results: 58.8% (90/153) patients underwent femoropopliteal bypass. 27.4% (42/153) patients underwent the hybrid procedure and 13.72% (21/153) patients underwent endovascular procedure. The primary patency rate of open surgery at 1 year is 85.6%, hybrid procedure (iliac stenting and fem-pop bypass is 78.9%, transfemoral thrombectomy and balloon angioplasty is 91.2%), endovascular procedure (primary superficial femoral artery drug-eluting balloon angioplasty is 94.4%, atherectomy is 70.3%). Secondary patency rate of open surgery and hybrid procedure was 94.6%, endovascular surgery was 50%. There was no significant difference in limb salvage rate in all three groups. Acute coronary syndrome occurred in 4% of patients in open femoro-popliteal bypass group, 5% patients in the endovascular group, 3.8% in the hybrid group. Cerebro-vascular accident (CVA) in 1.5% patients open fem-pop group and 1.5% patients in the endovascular group in follow-up period. Conclusion: Although open revascularization remains the treatment of choice for advanced atherosclerotic diseases involving femoropopliteal segment (TASC D), endovascular and hybrid procedures are not inferior to open surgery. There is a role for hybrid procedures as they augment the technical success rate of pure endovascular interventions for complex TASC D femoropopliteal lesion. Hybrid procedures can be an alternative in patients with multiple comorbidities giving equal short-term results and decreased morbidity.