P-099 - HEAD-TO-HEAD COMPARISON OF ENDOVASCULAR VERSUS OPEN REVASCULARIZATION IN LONG FEMOROPOPLITEAL LESIONS

TOPIC:
Peripheral Occlusive Arterial Disease
AUTHORS:
Enzmann F. (Department of Vascular Surgery, Medical University Innsbruck ~ Innsbruck ~ Austria) , Gratl A. (Department of Vascular Surgery, Medical University Innsbruck ~ Innsbruck ~ Austria) , Kluckner M. (Department of Vascular Surgery, Medical University Innsbruck ~ Innsbruck ~ Austria)
Introduction:
The current ESVS Guidelines for the treatment of long femoropopliteal lesions are not based on a high level of evidence. Randomized controlled trials (RCT) comparing endovascular interventions and bypass surgery are scarce and either outdated, as the BASIL trial, or only report short-term results. Endovascular techniques have evolved significantly ince BASIL, where only plain balloon angioplasty was used, and vein bypass (VBP) as the recommended therapy is challenged by recent RCTs (1,2).
Methods:
This study compared prosthetic (PTFE) bypass, VBP and angioplasty with nitinol stents for the treatment of long femoropopliteal lesions (Global Limb Anatomic Staging System - Femoropopliteal Grade 3 and 4). Pooled data from a RCT (1) and a retrospective database with the same inclusion criteria were analyzed with primary and secondary patency as well as freedom from target lesion revascularization (TLR) as primary endpoints.
Results:
Between 2016 and 2020 a total of 332 lesions were treated in three groups (PTFE: n = 114, VBP: n = 109, stent: n = 109). Clinical and lesion characteristics were similar with mean lesion lengths between 264 and 274mm. Technical success rate in the stent group was 88%. There were no significant differences between the groups in patency rates, freedom from TLR, limb salvage and survival. At 4 years the primary patency rates for the PTFE, VBP and stent groups were 36%, 48% and 32% (p=0.236), the secondary patency rates were 49%, 69% and 50% (p=0.054). The PTFE group had significantly less complications compared to the other groups and a shorter hospital-stay compared to the VBP group. Clinical improvement (change of Rutherford categories) was significantly better in the PTFE and VBP group compared to the stent group.
Conclusion:
The 4-year results of this study indicate that the role of VBP as the recommended therapy for long femoropopliteal lesions may not be unchallenged. Clinical improvement in both bypass groups was significantly better compared to angioplasty, but the PTFE and stent groups shorter hospital stay and lower complication rates are considerable advantages.
References:
1. Enzmann F. et al. Vein Bypass versus Nitinol Stent in Long Femoropopliteal Lesions: 4-Year Results of a Randomized Controlled Trial. Ann Surg. 2022 Feb 17. doi: 10.1097/SLA.0000000000005413. 2. Reijnen M. et al. 1-Year results of a multicenter randomized controlled trial comparing heparin-bonded endoluminal to femoropopliteal bypass. JACC Cardiovasc Interv. 2017;10:2320-2331.