Long-Term Results of Open Versus Endovascular Revascularization of Superficial Femoral Artery Occlusive Disease: A Case-Control Series

Abstract

Introduction: We performed a case-control comparison of long-term results of femoral-popliteal bypass and superficial femoral artery (SFA) endovascular interventions to examine characteristics of patients and procedures to optimize results. Methods: Femoral-popliteal bypasses and SFA interventions performed for consecutive patients with symptoms (Rutherford 3 to 6) between 2001 and 2008 were reviewed. Time-dependent outcomes were assessed with Kaplan-Meier survival analyses. Log-rank analyses, univariate, and multivariate analyses were performed. Results: During the study period, 152 limbs in 141 patients (66% male; mean age, 66 ± 22 years) underwent femoral-popliteal bypass; 233 limbs in 204 patients (49% male; mean age, 70 ± 11 years) underwent SFA intervention. Surgery was performed less commonly for claudication (46% vs 56%) and more commonly for critical ischemia (54% vs 44%). Six-year primary, primary assisted, and secondary patency rates were 56%, 64%, and 75%, respectively, for bypass patients and 40%, 67%, and 85%, respectively, for SFA interventions. Six-year limb salvage was 80% for surgery and 92% for SFA interventions. Complications occurred in 21% of the surgery group and in 1.2% of the endovascular group. Reintervention was required in 24% of surgery patients and in 14% of endovascular patients. Failure of SFA intervention led to bypass in 5% of patients; however, prior failed intervention did not change the target artery. Predictors of failure for surgery and SFA interventions were female gender, diabetes, creatinine >1.8 mg/dL, and critical limb ischemia; however, limb salvage was no different for all groups. Conclusions: Although long-term patency and limb salvage were equivalent, reinterventions and complications occurred at a higher rate in the surgery group. Patients with critical limb ischemia, diabetes, or renal failure had decreased patency with both treatments; however, limb salvage was not disadvantaged for any group. SFA stent placement should therefore be the initial therapy for patients with SFA occlusive disease.