Femoro-popliteal bypass versus remote endarterectomy: a propensity matched analysis.

IF 1.5 4区医学 Q3 PERIPHERAL VASCULAR DISEASE International Angiology Pub Date : 2024-06-01 Epub Date: 2024-07-11 DOI:10.23736/S0392-9590.24.05216-7

Saaya B Shoraan, Alexander A Gostev, Olesya S Osipova, Alexey V Cheban, Pavel V Ignatenko, Vladimir B Starodubtsev, Andrey A Karpenko

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Abstract

Background: The purpose of this study was to compare femoropopliteal bypass (FPB) and remote endarterectomy (RE) for long femoropopliteal lesions.

Methods: Single center retrospective propensity matching analysis of the symptomatic patients with long occlusion of the femoro-popliteal segment (>250 mm), who underwent femoro-popliteal bypass above the knee or remote endarterectomy from 2014 to 2020. Primary endpoints: primary patency (PP), secondary patency (SP), target lesion revascularization (TLR). Secondary endpoints: MALE, MACE, clinical improvement and survival.

Results: Four hundred patients were divided into two groups: 200 in the FPB group and 200 in the RE group. As a result of propensity score matching, 110 (FPB) and 109 (RE) patients remained. Three-year primary patency rates were 62% for FPB vs. 53% for RE, P=0.16. Secondary patency rates were 84% for FPB vs. 75% for RE, P=0.10. Freedom from TLR were 61% for FPB vs. 71% for RE P=0.21. Survival and amputation-free survival (AFS) also did not differ (93% vs. 94%, P=0.81 and 87% vs. 92%, P=0.19 respectively). Primary patency of the GSV higher than RE (P=0.00) and PTFE (P=0.00). It was established statistically advantages of RE and great saphenous vein (GSV) bypass over a PTFE bypass in SP (P=0.01 P=0.03), TLR (P=0.02 P=0.00) and AFS (P=0.03 P=0.01).

Conclusions: Surgical treatment of long femoropopliteal occlusions with an autovenous bypass or remote endarterectomy showed significantly better results in secondary patency, TLR and AFS than the use of PTFE prostheses. GSV remains the gold standard for femoropopliteal bypass surgery.

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股骨头旁路术与远端动脉内膜切除术：倾向匹配分析。

背景：本研究的目的是比较股骨头搭桥术（FPB）和远端内膜剥脱术（RE）治疗股骨头长段病变：本研究的目的是比较股腘旁路术（FPB）和远端内膜剥脱术（RE）对股腘长段病变的治疗效果：方法：对2014年至2020年期间接受膝上股骨头旁路术或远端内膜剥脱术的股腘段长闭塞（>250毫米）的无症状患者进行单中心回顾性倾向匹配分析。主要终点：主要通畅率（PP）、次要通畅率（SP）、靶病变血运重建率（TLR）。次要终点：结果：400名患者被分为两组：FPB组200人，RE组200人。经过倾向评分匹配，最终剩下 110 名（FPB 组）和 109 名（RE 组）患者。FPB 组的三年初次通畅率为 62%，RE 组为 53%，P=0.16。FPB的二次通畅率为84%，RE为75%，P=0.10。FPB的TLR治愈率为61%，RE为71%，P=0.21。存活率和无截肢存活率（AFS）也没有差异（分别为 93% vs. 94%，P=0.81 和 87% vs. 92%，P=0.19）。GSV的初次通畅率高于RE（P=0.00）和PTFE（P=0.00）。据统计，在SP（P=0.01 P=0.03）、TLR（P=0.02 P=0.00）和AFS（P=0.03 P=0.01）方面，RE和大隐静脉（GSV）搭桥术比PTFE搭桥术更具优势：结论：使用自体静脉旁路或远端动脉内膜切除术对股骨长段闭塞进行手术治疗，在二次通畅率、TLR和AFS方面的效果明显优于使用PTFE假体。GSV仍是股腘旁路手术的金标准。

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来源期刊

International Angiology 医学-外周血管病

CiteScore

2.80

自引率

28.60%

发文量

审稿时长

6-12 weeks

期刊介绍： International Angiology publishes scientific papers on angiology. Manuscripts may be submitted in the form of editorials, original articles, review articles, special articles, letters to the Editor and guidelines. The journal aims to provide its readers with papers of the highest quality and impact through a process of careful peer review and editorial work. Duties and responsibilities of all the subjects involved in the editorial process are summarized at Publication ethics. Manuscripts are expected to comply with the instructions to authors which conform to the Uniform Requirements for Manuscripts Submitted to Biomedical Editors by the International Committee of Medical Journal Editors (ICMJE).