Comparison of Endovascular Versus Bypass Surgery in Femoropopliteal TASC II D Lesions: A Single-Center Study
| Autor: | Paolo Criscenti, Marco Macrì, Gian Franco Veraldi, Ranieri Poli, Arianna Corvasce, Luca Mezzetto |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Time Factors medicine.medical_treatment Kaplan-Meier Estimate 030204 cardiovascular system & hematology Revascularization Prosthesis Design Severity of Illness Index 03 medical and health sciences Blood Vessel Prosthesis Implantation Peripheral Arterial Disease 0302 clinical medicine Restenosis Blood vessel prosthesis Risk Factors Angioplasty Medicine Humans Popliteal Artery 030212 general & internal medicine Vascular Patency Aged Retrospective Studies Aged 80 and over Univariate analysis Chi-Square Distribution business.industry General Medicine Critical limb ischemia Middle Aged medicine.disease Limb Salvage Surgery Blood Vessel Prosthesis Femoral Artery Treatment Outcome Bypass surgery Italy Female Stents medicine.symptom Cardiology and Cardiovascular Medicine business Claudication Angioplasty Balloon |
| Zdroj: | Annals of vascular surgery. 47 |
| ISSN: | 1615-5947 |
| Popis: | Background In patients with severe occlusive disease (Trans-Atlantic Inter-Society Consensus II D [TASC II D]) of the femoropopliteal segment, the advantages of endovascular versus bypass revascularization still remain debated. Most reports available in literature comparing percutaneous transluminal angioplasty (PTA) ± bare metal stent (BMS) versus synthetic bypass analyze patients with heterogeneous anatomical lesions creating possible bias when results of different treatments are matched. In this study, we compared early and midterm outcomes of PTA ± BMS versus heparin-bonded expanded polytetrafluoroethylene graft (Propaten-Gore) + Linton patch in patient affected by symptomatic femoropopliteal TASC II-D lesions. Methods Eighty limbs with symptomatic severe occlusive disease (TASC II D) of the femoropopliteal segment observed from January 2013 to January 2017 were included in this retrospective study. Indication to treatment was severe claudication in 17 limbs (21.2%) and critical limb ischemia (CLI) in 63 (78.8%). 36.2% of limbs presented at least 2 distal patent vessels, and 63.8% had only 1 patent vessel. Of these limbs, 40 were treated by means of PTA ± BMS (group A), and 40 were treated by means of femoropopliteal bypass with Propaten-Gore graft + Linton patch (group B). Patients were followed with a clinical assessment and duplex at 1, 6, and 12 months after procedure and then annually. A closer follow-up was performed in case of any complication. Patency, reintervention rate, and limb salvage were compared in the 2 groups. Results The mean length of arterial occlusion was 22.1 cm (range, 8–37) in group A versus 25.2 cm (range, 9–41) in group B, P = ns. A slight difference in mean procedural time was observed (83.5 min of group A versus 114 min of group B, minutes, P = 0.02). Mean follow-up was 26.7 months (range, 3–46). Primary patency at 6, 12, and 24 months of group A versus group B was 76.9% vs. 97.5% (P = 0.007), 65.7% vs. 89.1% (P = 0.05), and 52.6% vs. 78.1% (P = 0.005), respectively. Assisted primary patency was 76.9% vs. 97.5% (P = 0.007), 68.5% vs. 91.8% (P = 0.02), and 57.8% vs. 87.5% (P = 0.001), respectively. Secondary patency was 94.8% vs. 97.5% (P = ns), 85.7% vs. 97.2% (P = ns), 73.6% vs. 93.7% (P = 0.004), respectively. Rate of reintervention at 24 months was 45% in group A vs. 20% in group B (P = 0.03). Limb salvage rate at 24 months was 90% for group A vs. 92.5% for group B (P = ns). Univariate analysis showed CLI and poor runoff to be independent risk factors for significant restenosis/occlusion of target artery and reintervention. Conclusions In patients with severe femoropopliteal occlusive disease (TASC II D), the surgical revascularization by means of Propaten-Gore bypass + Linton patch can be considered safe and effective. Early and midterm results of this approach seem to be superior to PTA ± BMS in terms of restenosis/occlusion and reintervention rates. Larger cohort and longer term results are mandatory to better define this advantage. |
| Databáze: | OpenAIRE |
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