Long-Term Outcome of Bypass Surgery versus Endovascular Revascularization in Long Femoropopliteal Lesions
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Revascularization Protocol
2.3. Statistics
3. Results
3.1. Peri- and Postoperative Results
3.2. Patency Rates
3.3. Ranking
3.4. Clinical Outcome
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Stent (n = 103, 109 Lesions) | VBP (n = 106, 109 Lesions) | PTFE (n = 107, 114 Lesions) | p Value $ | |
---|---|---|---|---|
Age (years) | 69.3 ± 7 | 68.5 ± 7.8 | 68.7 ± 9.4 | 0.990 ◊ |
Male | 69 (67) | 78 (74) | 70 (65) | 0.269 § |
Cardiovascular risk factors | ||||
Atrial fibrillation | 15 (15) | 15 (14) | 11 (10) | 0.527 § |
Coronary artery bypass | 15 (14) | 3 (3) | 11 (10) | 0.014 § |
Coronary artery disease | 48 (47) | 31 (29) | 36 (34) | 0.033 § |
Diabetes mellitus | 36 (35) | 40 (38) | 34 (32) | 0.691 § |
Dyslipidemia | 63 (61) | 69 (65) | 38 (36) | <0.001 § |
Hemodialysis | 3 (3) | 3 (3) | - | 0.138 § |
Hypertension | 89 (86) | 88 (83) | 77 (72) | 0.033 § |
Prior stroke | 12 (12) | 10 (9) | 9 (8) | 0.667 § |
Rutherford category | 0.361 § | |||
3 | 51 (47) | 51 (47) | 60 (56) | |
4 | 17 (16) | 14 (13) | 14 (13) | |
5 | 39 (36) | 43 (40) | 29 (27) | |
6 | 2 (2) | 1 (1) | 3 (3) | |
CLTI | 58 (53) | 58 (53) | 46 (43) | 0.116 § |
ASA classification | 0.787 § | |||
I | 1 (1) | 1 (1) | 1 (1) | |
II | 25 (24) | 29 (27) | 31 (29) | |
III | 77 (75) | 76 (72) | 74 (69) |
Stent (n = 109) | VBP (n = 109) | PTFE (n = 114) | p Value | |
---|---|---|---|---|
Lesion length (mm) | 264 ± 59 | 272 ± 70 | 274 ± 58 | 0.427 ◊ |
TASC II type | ||||
C | 48 (44) | 48 (44) | 51 (45) | 0.993 § |
D | 61 (56) | 61 (56) | 63 (55) | 0.993 § |
Previous intervention ipsilateral | 31 (28) | 49 (45) | 29 (25) | 0.004 § |
Chronic total occlusion | 87 (80) | 96 (88) | 107 (94) | 0.007 § |
Reference vessel diameter (mm) | 5 ± 0.7 | 5 ± 1 | 5.1 ± 1.1 | 0.783 ◊ |
Number of stenosis free outflow vessels | ||||
1 | 26 (24) | 21 (19) | 20 (18) | 0.482 |
2 | 53 (49) | 54 (50) | 44 (39) | 0.188 |
3 | 30 (30) | 34 (31) | 50 (44) | 0.026 |
CFA endarterectomy | - | 39 (36) | 33 (29) | <0.001 § |
Infragenicular bypass | - | 60 (55) | 12 (11) | <0.001 § |
ePTFE graft | - | - | 12 (11) | |
Ipsilateral GSV | - | 100 (92) | - | |
Alternative vein graft | - | 9 (8) | - | |
Reversed vein graft | - | 15 (14) | - | |
Stent diameter (mm) * | 6 ± 0.5 | - | - | |
Stented lesion length (mm) * | 248 ± 98 | - | - | |
Number of stents * | 4 ± 2 | - | - | |
CFA angioplasty | 4 (4) | - | - | |
Popliteal stenting * | 30 (28) | - | - | |
Procedural length | 72 ± 31 | 181 ± 63 | 142 ± 54 | p < 0.001 |
Stent (n = 103; 109 Lesions) | VBP (n = 106; 109 Lesions) | PTFE (n = 107; 114 Lesions) | p Value | |
---|---|---|---|---|
Patients with ≥ 1 complication | 7 (6) | 12 (11) | 1 (1) | 0.007 § |
Local complications | ||||
Superficial SSI | - | 14 (13) | 8 (7) | 0.001 § |
Deep SSI | - | 9 (8) | 3 (3) | 0.004 § |
Bleeding/pseudoaneurysm | 6 (6) | 6 (6) | 3 (3) | 0.543 § |
Distal embolization | 7 (7) | - | - | |
Vessel perforation | 10 (9) | - | - | |
Unplanned minor amputation | 4 (4) | 1 (1) | 1 (1) | 0.080 § |
Systemic complications | ||||
Anemia/blood transfusion | 5 (5) | 20 (18) | 4 (4) | <0.001 § |
Myocardial Infarction | 1 (1) | 1 (1) | 2 (2) | 0.797 § |
Renal function deterioration | 3 (3) | 4 (4) | - | 0.140 § |
Predictor | Rank | Gain Ratio Merit | OR [95% CI] | p-Value |
---|---|---|---|---|
Surgery type Stent (vs. VBP) PFTE (vs. VBP) | 1.7 ± 0.6 | 0.02 ± 0.003 | 0.532 [0.302 to 0.938] 0.324 [0.176 to 0.595] | 0.001 0.029 0.000 |
Rutherford classification 5/6 | 2.8 ± 0.92 | 0.016 ± 0.002 | 0.742 [0.344 to 1.604] | 0.448 |
CLTI | 3.9 ± 0.94 | 0.014 ± 0.002 | 0.726 [0.356 to 1.480] | 0.378 |
Superficial surgical site infection | 5.4 ± 1.64 | 0.011 ± 0.003 | 0.739 [0.252 to 2.170] | 0.582 |
Atrial fibrillation | 5.8 ± 1.83 | 0.01 ± 0.003 | 0.620 [0.289 to 1.331] | 0.220 |
Diabetes mellitus | 6.9 ± 1.44 | 0.009 ± 0.002 | 0.719 [0.425 to 1.216] | 0.219 |
Hypertension | 7.5 ± 1.87 | 0.008 ± 0.002 | 1.559 [0.824 to 2.950] | 0.172 |
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Kluckner, M.; Gruber, L.; Wippel, D.; Lobenwein, D.; Westreicher, W.; Pilz, M.; Enzmann, F.K. Long-Term Outcome of Bypass Surgery versus Endovascular Revascularization in Long Femoropopliteal Lesions. J. Clin. Med. 2023, 12, 3507. https://doi.org/10.3390/jcm12103507
Kluckner M, Gruber L, Wippel D, Lobenwein D, Westreicher W, Pilz M, Enzmann FK. Long-Term Outcome of Bypass Surgery versus Endovascular Revascularization in Long Femoropopliteal Lesions. Journal of Clinical Medicine. 2023; 12(10):3507. https://doi.org/10.3390/jcm12103507
Chicago/Turabian StyleKluckner, Michaela, Leonhard Gruber, David Wippel, Daniela Lobenwein, Werner Westreicher, Manuela Pilz, and Florian K. Enzmann. 2023. "Long-Term Outcome of Bypass Surgery versus Endovascular Revascularization in Long Femoropopliteal Lesions" Journal of Clinical Medicine 12, no. 10: 3507. https://doi.org/10.3390/jcm12103507
APA StyleKluckner, M., Gruber, L., Wippel, D., Lobenwein, D., Westreicher, W., Pilz, M., & Enzmann, F. K. (2023). Long-Term Outcome of Bypass Surgery versus Endovascular Revascularization in Long Femoropopliteal Lesions. Journal of Clinical Medicine, 12(10), 3507. https://doi.org/10.3390/jcm12103507