Three‐year comparable clinical outcome for Trans‐Atlantic Inter‐Society Consensus (TASC) D femoropopliteal occlusion: Endovascular vs bypass surgery

Abstract

<h3>Aim</h3><p>To evaluate the difference between endovascular surgery and bypass/hybrid approach in treating Trans-Atlantic Inter-Society Consensus (TASC) D femoropopliteal occlusion.</p><h3>Patients and Methods</h3><p>This is a 10-year retrospective cohort study including 75 patients with TASC D femoropopliteal occlusion with revascularisation from 2009 to 2018. Cases were retrieved from the Clinical Data Analysis and Reporting System. Demographics, lesions characteristics, operative findings and follow-up data were reviewed.</p><h3>Results</h3><p>A total of 65% of patients had endovascular intervention, 23% open bypass and 12% hybrid operation. The endovascular group had fewer critical limb ischaemia (endovascular 43%, bypass 94%, hybrid 100%; <em>P</em> < .001), and shorter length of lesion (endovascular 26.4 cm vs bypass/hybrid 31.0 cm; <em>P</em> = .004). The technical success rate of the endovascular group was 87.8%. Different endovascular treatment strategies were used. The 12-month primary patency rate of the endovascular group was lower (endovascular 69.7% vs bypass 81.3% vs hybrid 75.0%; <em>P</em> = .67) but the secondary patency rate at 3 years after the operation was similar across all groups (endovascular 83.3% vs bypass 78.6% vs hybrid 87.5%; <em>P</em> = .86).</p><h3>Conclusion</h3><p>Endovascular treatment for long and complex femoropopliteal occlusion is technically feasible with a high success rate. Close surveillance with prompt reintervention may help achieve 3 years’ comparable patency of endovascular intervention to traditional surgical bypass. Individualised plan of revascularisation should be considered.</p>