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. 2023 Nov;78(5):1270-1277.
doi: 10.1016/j.jvs.2023.07.053. Epub 2023 Jul 31.

Bypass vs endovascular treatment for occluded femoro-popliteal stents in patients with critical limb-threatening ischemia

Mario D'Oria  1 , Raffaella Berchiolli  2 , Mauro Gargiulo  3 , Michele Antonello  4 , Giovanni Pratesi  5 , Stefano Michelagnoli  6 , Roberto Silingardi  7 , Giacomo Isernia  8 , Gian Franco Veraldi  9 , Giovanni Tinelli  10 , Rocco Giudice  11 , Arnaldo Ippoliti  12 , Pierluigi Cappiello  13 , Massimiliano Martelli  14 , Sandro Lepidi  15 , Nicola Troisi  2 ; OUTSTEPP2 Collaborative Study Group
Collaborators, Affiliations
Free article

Bypass vs endovascular treatment for occluded femoro-popliteal stents in patients with critical limb-threatening ischemia

Mario D'Oria et al. J Vasc Surg. 2023 Nov.
Free article

Abstract

Objective: The aim of the study was to compare the early and medium-term outcomes of bypass vs endovascular treatment of occluded femoro-popliteal stents in patients with chronic limb-threatening ischemia (the OUT-STEPP multicentric registry).

Methods: Between January 2016 and December 2021, 317 patients in 14 centers underwent treatment for a symptomatic occlusion of femoro-popliteal stent/stents. One hundred sixty-one patients were included into the present study: 46 (28.6%) underwent open bypass surgery (Group OPEN), and 115 (71.4%) underwent endovascular revascularization (Group ENDO). Early (30 days) results were assessed and compared between the two groups. Estimated 5-year outcomes were evaluated and compared with the log rank test.

Results: At 30 days, no differences were found in terms of major adverse cardiovascular events, acute kidney injury, reinterventions, major amputation, and all-cause mortality between the two groups. The need for blood transfusions was higher for patients in Group OPEN (17; 36.9% vs 13; 11.3%; P < .001). The mean length of intensive care unit stay and the mean hospital stay were higher for patients in Group OPEN ([0.3 ± 0.9 vs 0 days; P < .001] and [9.7 ± 5.8 vs 3.3 ± 1.4 days; P < .001], respectively). The overall median duration of follow-up was 33.1 months (interquartile range, 14-49.5 months). At 5 years, there were no differences between the two groups in terms of survival (68.7% Group OPEN vs 68.8% Group ENDO; P = .27; log-rank, 1.21), primary patency (56.3% Group OPEN vs 67.8% Group ENDO; P = .39; log-rank, 0.75), secondary patency (59.1% Group OPEN vs 77.8% Group ENDO; P = .24; log-rank, 1.40), absence of target lesion restenosis (56.8% Group OPEN vs 62.7% Group ENDO; P = .42; log-rank, 0.65), and limb salvage (77.2% Group OPEN vs 90.4% Group ENDO; P = .17; log-rank, 1.87).

Conclusions: Both bypass and endovascular treatment provided safe and effective restoration of patency for femoro-popliteal in-stent occlusion in patients with chronic limb-threatening ischemia. Open surgery was associated with longer stay in hospital and increased use of blood transfusions. At 5 years, no significant differences were found in the rates of overall patency or limb salvage between bypass and endovascular treatment.

Keywords: Femoro-popliteal artery; Multicenter; Peripheral arterial disease; Stent; Thrombosis.

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