Comparison of Prosthetic and Vein Bypass with Nitinol Stents in Long Femoropopliteal Lesions

Michaela Kluckner,Alexandra Gratl,Sabine H Wipper,Wolfgang Hitzl,Patrick Nierlich,Manuela Aspalter,Klaus Linni,Florian K Enzmann

doi:10.1016/j.avsg.2021.05.052

Michaela Kluckner, Alexandra Gratl + Show 6 more

Open Access

https://doi.org/10.1016/j.avsg.2021.05.052

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Abstract

Guidelines for the treatment of long femoropopliteal lesions are not based on a high level of evidence and recent randomized controlled trials (RCTs) challenge vein bypass (VBP) as the recommended therapy. This study compared prosthetic (PTFE) bypass, VBP and angioplasty with nitinol stents in long femoropopliteal lesions. Pooled data from a RCT and a retrospective database with the same inclusion criteria were analyzed with primary and secondary patency as well as freedom from target lesion revascularization (TLR) as primary endpoints. Between 2016 and 2018 a total of 172 lesions were treated in three groups (PTFE: n=62, VBP: n=55, stent: n=55). Clinical and lesion characteristics were similar with mean lesion lengths between 260 and 279mm. Technical success rate in the stent group was 87%. There were no significant differences between the groups in patency rates, freedom from TLR, limb salvage and survival during 2-year follow-up. The primary patency rates for the PTFE, VBP and stent groups were 50%, 56% and 60% at 2 years. The PTFE group had significantly less complications compared to the other groups and a shorter hospital-stay compared to the VBP group. Clinical improvement was significantly better in the PTFE and VBP group compared to the stent group. The 2-year results indicate that the role of VBP as the recommended therapy for long femoropopliteal lesions may not be unchallenged due to the similar results in all three groups. Further RCTs are needed to determine the best revascularization modality for long femoropopliteal lesions.

Highlights

Lesions of the femoropopliteal arteries are treated in half of all surgical and endovascular procedures for peripheral arterial disease (PAD).[1]
All femoropopliteal bypasses implanted in Innsbruck between March 2016 and March 2018 were screened for the same inclusion and exclusion criteria that were used for the randomized controlled trials (RCTs)
Between March 2016 and March 2018 a total of 185 patients with femoropopliteal bypass procedures were screened for study entry, but 125 patients were excluded, due to ipsilateral iliac artery lesions (n = 40), previous ipsilateral bypass surgery (n = 31), use of a vein conduit (n = 26), non-atherosclerotic lesions, embolic occlusion (n = 7), a Trans-Atlantic Inter-Society Consensus (TASC) II type B lesion (n = 5), acute ischemia (n = 3), chronic kidney disease without requiring dialysis (n = 2) and hybrid procedure (n = 1)

Summary

Introduction

Lesions of the femoropopliteal arteries are treated in half of all surgical and endovascular procedures for peripheral arterial disease (PAD).[1] For the choice of treatment modality several guidelines have been published with the Trans-Atlantic Inter-Society Consensus (TASC) document and the ESC/ESVS guidelines on the diagnosis and treatment of peripheral arterial disease being two of the most influential Both recommend endovascular treatment for short femoropopliteal lesions (TASC:

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