Bypass versus endovascular revascularization for patients with atherosclerotic occlusive disease of the superficial femoral artery.

Background

Atherectomy emerged recently as an interventional modality for vessel preparation with high rates of mid-term primary patency. However, data regarding the comparison of rotational atherectomy for long calcified lesions with bypass surgery above-the-knee are lacking. Aim to investigate early and mid-term outcomes of this endovascular treatment compared to bypass surgery. Patients and methods: In this retrospective analysis, patients with de novo occlusive TASC D lesions of the superficial femoral artery (SFA) were included. A synthetic above-knee femoropopliteal bypass was preferred as the initial treatment approach for patients with absence of a patent origin/stump of the SFA (group A). On the other hand, in case of patent stump of the SFA of at least 1 cm or more, an endovascular approach with rotational atherectomy and DCB angioplasty with bail-out stenting was preferred (group B).

Results

Thirty-eight patients formed group A, and thirty-nine group B. Technical success/stent free technical success was met in 37/38 patients in group A and in 29/39 patients in group B respectively (p<.001). Primary patency was 89.5% in group A compared to 94.7% in group B (log rank test: p=.468), while the secondary patency was 94.9% versus 94.7% (log rank test: p=.068). In group B, two patients required re-intervention 24 months after the initial procedure. In group A, two patients suffered from bypass occlusion occurring 8 months after the initial procedure and unterwent a re-intervention.

Conclusions

Endovascular atherectomy-assisted revascularisation and prosthetic bypass exhibit good patency. The time of occurrence of re-interventions differ between the 2 groups unterlining the need for meticulous follow up.