Study Compares Surgical Bypass Versus Angioplasty and Stent Treatment in SFA

January 7, 2014—In the Journal of Vascular Surgery, Mahmoud B. Malas, MD, et al published findings from a study conducted to evaluate contemporary outcomes of femoropopliteal bypass compared with angioplasty and stent treatment in patients with symptomatic peripheral arterial disease in terms of patency and reintervention rates (2014;59:129–135).

In their conclusions, the investigators state that this is the first study documenting higher reintervention rates for femoropopliteal bypass compared with angioplasty and stenting. They believe the main reason for this finding is the fact that the bypass patients had significantly more advanced disease, which emphasizes that physicians must consider the patient population undergoing intervention when comparing revascularization procedures. A prospective, randomized trial is needed to determine the overall better treatment option, noted the investigators.

As summarized in Journal of Vascular Surgery, the investigators identified all patients who were evaluated at the Johns Hopkins Bayview Medical Center in Baltimore, Maryland with the presumptive diagnosis of PAD from September 2005 to September 2010. The investigators reported that out of these 1,237 patients, they identified 104 symptomatic patients who received percutaneous transluminal angioplasty/stenting of the superficial femoral artery or femoropopliteal bypass after failing medical management. There were 61 male patients (56%), and the mean age was 68 years in both groups. Both treatment groups had similar risk factors.

The overall patency and reintervention rates were compared between the two groups, as well as patency within Transatlantic Intersociety Consensus (TASC) II subgroups. Descriptive analyses were performed using χ² and two-sided t-tests. The Mann-Whitney U test was used to compare distributions of continuous variables, and the Fisher exact test was used for categorical variables. The Cox proportional hazard model was used to examine the treatment effect within each lesion type, using the bypass group as the reference group.

Overall, 77% of patients with TASC II A and B lesions underwent angioplasty and stenting, whereas 73% of patients with TASC C and D lesions underwent bypass (P < .01). The primary patency at 24 months was better for the stent group (67%; 95% confidence interval [CI], 0.52 to 0.78) versus bypass group (49%; 95% CI, 0.32 to 0.64; P = .05). The rate of reintervention within the 2-year period was higher in the bypass group compared with the stent group (54% vs 31%; P = .02). TASC A and B lesions combined demonstrated a reduced hazard of patency failure compared with TASC C or D lesions combined (hazard ratio, 2.42; 95% CI, 1.26, 4.65; P < .01), reported the investigators in Journal of Vascular Surgery.