Stent vs. Bypass in Long Femoropopliteal Lesions - Stent vs. Bypass in Long Femoropopliteal Lesions
Contribution To Literature:
This trial showed that nitinol stents compared to saphenous vein bypass grafts resulted in similar outcomes for treatment of long femoropopliteal lesions.
The goal of the trial was to evaluate nitinol stents compared with bypass surgery with saphenous vein bypass grafts among patients with long femoropopliteal lesions.
Patients with long femoropopliteal lesions were randomized to endovascular nitinol stenting (n = 50) versus surgery with saphenous vein bypass graft (n = 53).
- Total number of enrollees: 103
- Duration of follow-up: Median 23 months
- Mean patient age: 70 years
- Percentage female: 30%
- Percentage with diabetes: 32%
Patients ≥30 years of age with:
- Severe intermittent claudication or critical limb ischemia
- Femoropopliteal Trans-Atlantic Inter-Society Consensus (TASC) II type C and D lesions
- Symptoms ≥2 months
- Acute ischemia
- Any form of vasculitis, embolic or traumatic femoropopliteal occlusions
- Previous ipsilateral bypass surgery
- Use of a prosthetic conduit
- Chronic kidney disease without requiring dialysis
- Advanced frailty
Other salient features/characteristics:
- Lesion length, 272 mm
- Chronic total occlusion, 82%
Primary study endpoints:
- Primary patency for the stent group was 60% vs. 56% in the bypass group at 24 months (p = 0.42).
- Primary assisted patency for the stent group was 63% vs. 71% in the bypass group at 24 months (p = 0.09).
- Secondary patency for the stent group was 72% vs. 73% in the bypass group at 24 months (p = 0.25).
- Freedom from target lesion revascularization was 75% in the stent group vs. 67% in the bypass group at 24 months (p = 0.29).
- Limb salvage: 100% in the stent group vs. 88% in the bypass group (p = 0.057)
- Survival at 24 months: 90% in the stent group vs. 87% in the bypass group (p = 0.27)
- Amputation: 1 in the stent group vs. 4 in the bypass group (p = 0.17)
Among patients with long femoropopliteal lesions, endovascular treatment with nitinol stents resulted in similar outcomes compared to surgery with saphenous bypass grafts. An endovascular-first strategy for femoropopliteal lesions up to 300 mm appears to be a promising treatment strategy.
Enzmann FK, Nierlich P, Aspalter M, et al. Nitinol Stent Versus Bypass in Long Femoropopliteal Lesions: 2-Year Results of a Randomized Controlled Trial. JACC Cardiovasc Interv 2019;Nov 27:[Epub ahead of print].
Keywords: Amputation, Cardiac Surgical Procedures, Cardiology Interventions, Coronary Artery Bypass, Coronary Occlusion, Endovascular Procedures, Intermittent Claudication, Ischemia, Myocardial Revascularization, Stents, Vascular Diseases
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