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Open Versus Endovascular Treatment Of TASC C And D Femoropopliteal Occlusive Disease

Michael C Stoner, Dorian J deFreitas, Mark Manwaring, Clark Kardys, Ricardo Mendoza, Wes Hudson, Taft L Stallings, Frank M Parker, William M Bogey, Charles S Powell.
East Carolina University, Greenville, NC.

OBJECTIVES: The TransAtlantic Inter-Society Consensus (TASC) guidelines currently recommend surgical revascularization for complex (TASC class C and D) femoropopliteal occlusive disease. This study reviews a contemporary experience with both open and endovascular revascularization of such lesions.

METHODS: From 2003 - 2006, open and endovascular (TASC C and D) cases of femoropopliteal revascularization were retrospectively reviewed. Clinical and demographic variables potentially associated with the endpoints of clinical revascularization and limb salvage were collected. Hospital cost associated with the index procedure was obtained from an administrative database.

RESULTS: A total of 235 cases were identified (167 open, 68 endovascular: 59 TASC C, 9 TASC D). Indication by Rutherford classification was not significantly different between open and endovascular cases. Selective stenting was employed in 18 (26%) of the endovascular cases. The increase in ankle brachial index with similar in each group (open = +0.33 ± 0.1, endovascular = +0.21 ± 0.1, P = NS). Over a mean followup of 368 ± 22 days, secondary revascularization was required in 27 (16%) of open cases and 24 (35%) of endovascular cases (P < 0.01). Limb salvage rate was not significantly different in the two groups. Hospital stay was longer in the open group (6.1 ± 0.4 days versus 3.1 ± 0.67 days, P < 0.01). Total hospital cost was higher in the open surgical group compared to the endovascular group ($14,177 ± 1396 versus $9,220 ± 879, P < 0.01).

CONCLUSIONS: Open surgical treatment of complex femoropopliteal occlusive disease has a higher rate of primary revascularization when compared to contemporary endovascular cases. However, length of stay and hospital costs are higher in the open group. Careful case selection is required to identify patients in whom endovascular revascularization will provide both improved resource utilization and durable results.