Three‐year comparable clinical outcome for Trans‐Atlantic Inter‐Society Consensus (TASC) D femoropopliteal occlusion: Endovascular vs bypass surgery

Abstract

AbstractAimTo evaluate the difference between endovascular surgery and bypass/hybrid approach in treating Trans‐Atlantic Inter‐Society Consensus (TASC) D femoropopliteal occlusion.Patients and MethodsThis is a 10‐year retrospective cohort study including 75 patients with TASC D femoropopliteal occlusion with revascularisation from 2009 to 2018. Cases were retrieved from the Clinical Data Analysis and Reporting System. Demographics, lesions characteristics, operative findings and follow‐up data were reviewed.ResultsA total of 65% of patients had endovascular intervention, 23% open bypass and 12% hybrid operation. The endovascular group had fewer critical limb ischaemia (endovascular 43%, bypass 94%, hybrid 100%; P < .001), and shorter length of lesion (endovascular 26.4 cm vs bypass/hybrid 31.0 cm; P = .004). The technical success rate of the endovascular group was 87.8%. Different endovascular treatment strategies were used. The 12‐month primary patency rate of the endovascular group was lower (endovascular 69.7% vs bypass 81.3% vs hybrid 75.0%; P = .67) but the secondary patency rate at 3 years after the operation was similar across all groups (endovascular 83.3% vs bypass 78.6% vs hybrid 87.5%; P = .86).ConclusionEndovascular treatment for long and complex femoropopliteal occlusion is technically feasible with a high success rate. Close surveillance with prompt reintervention may help achieve 3 years’ comparable patency of endovascular intervention to traditional surgical bypass. Individualised plan of revascularisation should be considered.