SS2. Outcomes of Interventions for Recurrent Disease after Endoluminal Intervention for Superficial Femoral Artery Disease

Abstract

Aggressive endoluminal therapy for superficial femoral artery (SFA) occlusive disease is commonplace, but the outcomes of current management of recurrent disease has not been well defined. The purpose of this study is to examine the outcomes of endoluminal and open interventions for recurrent SFA disease. A database of patients undergoing endovascular treatment of the SFA between 1986 and 2008 was retrospectively queried. Patients who developed recurrent disease were selected. Kaplan-Meier survival analyses were performed to assess time-dependent outcomes. Factor analyses were performed using a Cox proportional hazard model for time dependent variables. Data are presented as mean±SEM. 735 limbs in 631 patients (64%% male, average age 67 years) underwent endovascular treatment for symptomatic SFA disease. The restenosis rate was 16±3% at 5 years. Of the 222 patients, 58 remained asymptomatic while 164 underwent repeat intervention (59% percutaneous and 41% bypass). Bypass was employed for more extensive recurrent disease (Table). While primary and Repeat PTA had equivalent patency and symptom relief, those undergoing bypass had significantly superior outcomes albeit with a higher morbidity (Table). TASC lesion and runoff were significant predictors of failure in the repeat PTA group.Tabled 1Primary PTARepeat PTABypassNumber Limbs at Risk (n)7359668Claudication (%)517136 †p<0.05 compared to Repeat PTA.Rest Pain / Tissue Loss (%)492964 †p<0.05 compared to Repeat PTA.TASC C and D lesions (%)384267 ⁎p<0.05 compared to Primary PTA.Mortality (%)120 †p<0.05 compared to Repeat PTA.Morbidity (%)161628 ⁎p<0.05 compared to Primary PTA.†p<0.05 compared to Repeat PTA.Freedom from Recurrent Symptoms (%)66±363±681±8⁎p<0.05 compared to Primary PTA.†p<0.05 compared to Repeat PTA.Primary Patency (%)60±363±468±5Assisted Primary Patency (%)71±374±384±7⁎p<0.05 compared to Primary PTA.†p<0.05 compared to Repeat PTA.Secondary Patency (%)73±973±393±8⁎p<0.05 compared to Primary PTA.†p<0.05 compared to Repeat PTA.Mean±SEM at five years follow up. p<0.05 compared to Primary PTA.† p<0.05 compared to Repeat PTA. Open table in a new tab Mean±SEM at five years follow up. Repeat percutaneous intervention for recurrent SFA disease is associated with similar outcomes to the primary intervention. However, bypass for recurrent disease is used more commonly for extensive disease and is associated with superior longterm outcomes. This study suggests that bypass rather than repeat PTA may be the better strategy for recurrent disease.