A Retrospective Comparison Between Hybrid Treatment and Prosthetic Above-the-Knee Femoro-Popliteal Bypass in the Managem
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ORIGINAL SCIENTIFIC REPORT
A Retrospective Comparison Between Hybrid Treatment and Prosthetic Above-the-Knee Femoro-Popliteal Bypass in the Management of the Obstructive Disease of the Superficial Femoral Artery Walter Dorigo1 • Gabriele Piffaretti2 • Aaron Fargion1 • Nicola Rivolta2 • Ruth L. Bush3 Elena Giacomelli1 • Chiara Guttadauro2 • Patrizio Castelli2 • Carlo Pratesi1
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Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Objective We assessed early and late outcomes following hybrid intervention (common femoral artery endarterectomy and superficial femoral artery (SFA) stenting) versus above-the-knee (AK) femoro-popliteal bypass performed for peripheral artery occlusive disease (PAOD) in a double-center retrospective comparative cohort study. Materials and methods From January 2006 to December 2017, 82 hybrid revascularizations with femoral endarterectomy and SFA stenting (HY Group) and 98 AK femoro-popliteal bypasses with femoral endarterectomy (BP Group) were performed at two academic vascular centers. The two groups were compared in terms of preoperative and intraoperative details and of perioperative (\30 days) outcomes with v2 test. Long-term results were compared using Kaplan–Meier curves and log-rank test. Results No differences were found in demographics variables, risk factors, comorbidities and clinical presentation between the two groups. Also perioperative outcomes were similar between the two groups. Median duration of follow-up was 38 months. At five years, the estimated survival rate was 60% in HY Group and 77.5% in BP Group (p = 0.002) Five-year primary patency rates were 46% in HY Group and 64% in BP Group (p = 0.005). Overall, 13 patients in HY Group required conversion to open surgery and 6 patients in BP Group underwent below-knee (n = 4) or distal (n = 2) bypass. The 5-year rate of limb maintenance was 85% in HY Group and 94% in BP Group (p = 0.1) and was not significantly different regardless of presentation, claudication or critical limb ischemia. Conclusions In patients with PAOD due to complex long lesions of the infrainguinal arteries, open-surgical treatment with AK bypass provided better long-term survival and patency rates compared to a hybrid approach.
Introduction
The paper was presented in the Plenary Session during the Vascular Annual Meeting, June 12–15, 2019, which took place in National Harbor, MD, USA & Walter Dorigo [email protected] 1
Department of Vascular Surgery, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
2
Department of Vascular Surgery, University of Insubria, Insubria, Italy
3
College of Medicine, University of Houston, Houston, USA
Endovascular surgery in the management of chronic occlusive disease of the superficial femoral artery (SFA) is considered as the first-line therapy both in claudicants and in patients with critical limb threatening ischemia (CLTI), particularly when the lesion’s length does not exceed 25 cm [1]. Patients with peripheral arterial occlusive disease (PAOD) are present with multiple or diffuse arter
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