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Home > Vascular Annual Meeting > PP41. Long-Term Results of Open vs. Endovascular...

PP41. Long-Term Results of Open vs. Endovascular Revascularization of Superficial Femoral Artery Occlusive Disease: A Case Control Series

Eva M. Rzucidlo1, Aja Bjerke2, Daniel Walsh1, Richard Powell1
1Dartmouth Hitchcock Medical Center, Lebanon, NH; 2Dartmouth Medical School, Hanover, NH

OBJECTIVES: For patients with superficial femoral artery (SFA) occlusive disease the most appropriate treatment has yet to be determined. We performed a case control comparison of long term results of femoral popliteal bypass and SFA endovascular interventions to examine the characteristics of patients and procedures to optimize results.

METHODS: All femoral-popliteal bypasses and SFA interventions performed for consecutive patients with symptoms Rutherford 3 to 6 between 2001 and 2008 were reviewed. Kaplan Meir survival analyses were performed to assess time-dependent outcomes. 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. Six year primary, primary assisted and secondary patency rates were 40%, 67% and 85% respectively for SFA interventions. Six years limb salvage for surgery was 80%; six year limb salvage rate was 92% for SFA interventions. Complications occurred in 21% in the surgery group and in 1.2% of the endovascular group. Re-intervention 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 target artery. Predictors of failed patency for both the surgery and SFA intervention group were female gender, diabetes, creatinine >1.8, and critical limb ischemia. However, limb salvage was no different for all groups.

CONCLUSIONS: Though long-term patency and limb salvage were equivalent in this case controlled study of femoral popliteal bypass versus SFA interventions, re-inventions and complications occurred at a higher rate in the surgery group. Women, diabetics, and renal failure patients had sustained patency less frequently with both treatments; however, limb salvage was not disadvantaged for any group. SFA stent placement should therefore be initial therapy for patients with SFA occlusive disease.

AUTHOR DISCLOSURES: E.M. Rzucidlo, None; A. Bjerke, None; D. Walsh, None; R. Powell, None.