Primary Patency in Drug-Eluting Stenting versus Bypass for Femoropopliteal Occlusive Disease.

Overview

abstract

INTRODUCTION: Numerous studies have compared the outcomes of bypass and bare-metal stent in the management of femoropopliteal occlusive disease. However, the available evidence has become scarce since the advent of paclitaxel drug-eluting stents (DESs). This study endeavors to assess and contrast the intermediate-termS real-world results of employing DES and bypass techniques in the treatment of individuals afflicted with femoropopliteal occlusive disease. MATERIALS AND METHODS: We identified all patients who underwent femoropopliteal revascularization at a single institution from January 2012 to December 2017. In this group, we selected all patients who received drug-eluting stents or underwent bypass using autogenous vein. We compared the primary patency, overall survival, and limb salvage at 2 y between the two groups. A comparison between the two groups within Trans-Atlantic Inter-Society Consensus (TASC) II subgroups was also performed. Multivariate Cox regression models were used to examine the treatment effect on the main outcomes. RESULTS: Of the study cohort, 129 patients (56.1%) received femoropopliteal bypass, while 101 patients (43.9%) underwent DES placement. Median follow-up time was 19 mo (interquartile range 11-29). Patients in the DES group were more likely to have TASC A and B lesions (77.2%), whereas 63% of patients in the bypass group had TASC C and D lesions. The overall 2-y primary patency estimates were 82.1% for the DES group compared to 59.2% for the bypass group (P < 0.001). After adjusting for age, gender, comorbidities, and TASC II, bypass use was associated with a greater than 2-fold increase in loss of primary patency [adjusted hazard ratio (95% confidence interval): 2.6 (1.3-5.1), P = 0.05]. When stratifying by lesions' characteristics, this finding persisted only among patients with TASC A/B lesions [adjusted hazard ratio (95% confidence interval): 3.2 (1.3-8), P = 0.009], but not among patients with TASC C/D lesions (P = 0.3). There were no differences in the 2-y overall survival (88.1% versus 87.8%) and limb salvage (92.5% versus 92%) between the DES and the bypass groups, respectively (All P > 0.1). These findings persisted after stratification by TASC II subgroups. CONCLUSIONS: The use of DES in a real-practice setting was associated with a higher primary patency among patients with TASC A and B lesions, whereas bypass did not offer an advantage in terms of patency in longer lesions (TASC C and D). Further studies of larger populations are required.