Comparison of Prosthetic and Vein Bypass with Nitinol Stents in Long Femoropopliteal Lesions.
Aged
Alloys
Angioplasty
/ adverse effects
Austria
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation
/ adverse effects
Databases, Factual
Female
Femoral Artery
/ diagnostic imaging
Humans
Male
Middle Aged
Peripheral Arterial Disease
/ diagnostic imaging
Popliteal Artery
/ diagnostic imaging
Prosthesis Design
Randomized Controlled Trials as Topic
Retrospective Studies
Stents
Time Factors
Treatment Outcome
Vascular Patency
Veins
/ transplantation
Journal
Annals of vascular surgery
ISSN: 1615-5947
Titre abrégé: Ann Vasc Surg
Pays: Netherlands
ID NLM: 8703941
Informations de publication
Date de publication:
Jan 2022
Jan 2022
Historique:
received:
15
04
2021
revised:
28
04
2021
accepted:
16
05
2021
pubmed:
27
8
2021
medline:
8
2
2022
entrez:
26
8
2021
Statut:
ppublish
Résumé
Guidelines for the treatment of long femoropopliteal lesions are not based on a high level of evidence and recent randomized controlled trials (RCTs) challenge vein bypass (VBP) as the recommended therapy. This study compared prosthetic (PTFE) bypass, VBP and angioplasty with nitinol stents in long femoropopliteal lesions. Pooled data from a RCT 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. Between 2016 and 2018 a total of 172 lesions were treated in three groups (PTFE: n = 62, VBP: n = 55, stent: n = 55). Clinical and lesion characteristics were similar with mean lesion lengths between 260 and 279mm. Technical success rate in the stent group was 87%. There were no significant differences between the groups in patency rates, freedom from TLR, limb salvage and survival during 2-year follow-up. The primary patency rates for the PTFE, VBP and stent groups were 50%, 56% and 60% at 2 years. The PTFE group had significantly less complications compared to the other groups and a shorter hospital-stay compared to the VBP group. Clinical improvement was significantly better in the PTFE and VBP group compared to the stent group. The 2-year results indicate that the role of VBP as the recommended therapy for long femoropopliteal lesions may not be unchallenged due to the similar results in all three groups. Further RCTs are needed to determine the best revascularization modality for long femoropopliteal lesions.
Sections du résumé
BACKGROUND
BACKGROUND
Guidelines for the treatment of long femoropopliteal lesions are not based on a high level of evidence and recent randomized controlled trials (RCTs) challenge vein bypass (VBP) as the recommended therapy. This study compared prosthetic (PTFE) bypass, VBP and angioplasty with nitinol stents in long femoropopliteal lesions.
METHODS
METHODS
Pooled data from a RCT 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
RESULTS
Between 2016 and 2018 a total of 172 lesions were treated in three groups (PTFE: n = 62, VBP: n = 55, stent: n = 55). Clinical and lesion characteristics were similar with mean lesion lengths between 260 and 279mm. Technical success rate in the stent group was 87%. There were no significant differences between the groups in patency rates, freedom from TLR, limb salvage and survival during 2-year follow-up. The primary patency rates for the PTFE, VBP and stent groups were 50%, 56% and 60% at 2 years. The PTFE group had significantly less complications compared to the other groups and a shorter hospital-stay compared to the VBP group. Clinical improvement was significantly better in the PTFE and VBP group compared to the stent group.
CONCLUSIONS
CONCLUSIONS
The 2-year results indicate that the role of VBP as the recommended therapy for long femoropopliteal lesions may not be unchallenged due to the similar results in all three groups. Further RCTs are needed to determine the best revascularization modality for long femoropopliteal lesions.
Identifiants
pubmed: 34437960
pii: S0890-5096(21)00532-X
doi: 10.1016/j.avsg.2021.05.052
pii:
doi:
Substances chimiques
Alloys
0
nitinol
2EWL73IJ7F
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
272-280Informations de copyright
Copyright © 2021. Published by Elsevier Inc.