Drug-eluting Stents Are Associated with Good Mid-term Outcomes For The Treatment Of Failing Infrainguinal Bypass Grafts

Abstract

<h3>INTRODUCTION AND OBJECTIVES</h3> We previously demonstrated that drug-eluting stents (DES) have reasonable short-term patency for the treatment of infrainguinal bypass stenoses. The aim of this study was to compare mid-term outcomes of DES, plain balloon angioplasty (PTA), percutaneous cutting balloon (PCB), and drug-coated balloon (DCB) interventions for failing infrainguinal bypasses. <h3>METHODS</h3> We conducted a retrospective review of patients with infrainguinal bypass stenoses treated by endovascular intervention (08/2010-07/2021). The primary outcome was primary patency (PP). Secondary outcomes were primary-assisted patency (PAP), secondary patency (SP) and limb salvage (LS). Outcomes are described stratified by treatment using Kaplan-Meier curves with log-rank tests at 6-month intervals post-intervention.FIGURE 1 <h3>RESULTS</h3> 73 consecutive patients with 154 discrete infrainguinal bypass stenoses were identified. Mean age was 65.2±10.6 years, 54.8% were male, and 47.9% were Black. 82.2% of patients were originally treated for chronic limb-threatening ischemia, and 57.8% of bypass distal anastomoses were to tibial or pedal targets. Of 154 lesions, 43.5% (n=67) were treated with PTA, 17.5% (n=27) with PCB, 17.5% (n=27) with DES, and 21.4% (n=33) with DCB. Median follow-up was 24.3 months (IQR 8.6-48.4). There was no difference in bypass configuration, conduit choice, or stenosis location (proximal anastomosis, mid-bypass, distal anastomosis). At short-term follow-up (6- and 12-months), there were no significant differences in any outcome between groups (all, P>0.05). At 18- and 24-months post-intervention, PAP and SP were best for DES, followed by PCB, PTA, and DCB (P<0.04; Figure 1). PP and LS did not differ between modalities at any time point. <h3>CONCLUSION</h3> DES are associated with superior patency rates, and should be considered a primary treatment modality for failing infrainguinal bypasses.