Abstract 14275: Long Term Results of Endovascular Therapy versus Femoral-popliteal Bypass for TASC II C or D Femoro-popliteal Lesions
Background: Although femoral-popliteal bypass (F-P bypass) has been the first line therapy for severe femoro-popliteal artery disease, long-term outcomes compared with endovascular therapy (EVT) has not been systematically examined. It remains unclear which patient is benefited most by EVT.
Methods: This multicenter, retrospective study included 350 Trans-Atlantic Intersociety Consensus (TASC II) C/D lesions in 260 patients (Mean age 72.9±8.8 years, male: 69%, claudication: 52%) receiving nitinol-stent-supported EVT and 102 TASC II C/D lesions in 92 patients (Mean age 71.1±8.5 years, male: 75%, claudication: 36%) receiving F-P bypass. The primary outcome measure was primary patency, which was compared by using Kaplan-Meier and log-rank testing. Association between EVT and the primary patency was assessed by Cox proportional hazard regression model.
Results: At 1, 3 and 5 years, primary patency was 70%, 60%, 43% in the EVT group and 88%, 74%, 65% in the F-P bypass group (p < 0.01), respectively. The hazard ratio of EVT for restenosis (relative to bypass) was calculated to be 1.96 (95%CI: 1.27 to 3.01) in the overall population. Subsequent analysis revealed that CRP≧1 and BMI≦18 had a significant interaction with EVT for restenosis. The hazard ratio of EVT was 3.27 (95%CI: 1.82 to 5.9) in cases of CRP<1 and 0.88 (95%CI: 0.44 to 1.73) in those of CRP≧1 (p for interaction<0.01), whereas it was 2.5 (95%CI: 1.52 to 4.2) in cases of BMI>18 and 0.74 (95%CI: 0.27 to 2) in those of BMI≦18 (p for interaction = 0.02). In cases of CRP≧1 or BMI≦18 (n = 166, 36%), 1-, 3-, and 5-year primary patency was 67%, 57%, 48% in the EVT group and 75%, 45%, 45% in the F-P bypass group (p = 0.84), respectively. Secondary patency, freedom from major adverse limb event, and amputation free survival were similar between EVT and bypass in the population (p = 0.19, 0.57, and 0.78, respectively).
Conclusion: EVT was inferior to F-P bypass in primary patency for TASC II C/D femoro-popliteal lesions. Nonetheless, in cases of CRP≧1 or BMI≦18, EVT demonstrated equal outcome to F-P bypass.
- © 2013 by American Heart Association, Inc.