Skip to main content
SpringerLink
Log in

Bypass Versus Interwoven Nitinol Stents for Long Femoro-Popliteal Occlusions: A Propensity Matched Analysis

  • Clinical Investigation
  • Arterial Interventions
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To compare femoro-popliteal bypass and interwoven nitinol stenting for long occlusions of the femoro-popliteal segment.

Materials and Methods

Single center retrospective propensity matching analysis of the symptomatic patients with long occlusion of the femoro-popliteal segment (> 20 cm), who underwent stenting with interwoven nitinol stent or femoro-popliteal bypass from 2012 to 2020. Primary endpoints: primary patency, primary-assisted patency, secondary patency. Secondary endpoints: major adverse cardiovascular events, major adverse limb events, primary sustained clinical improvement, survival.

Results

A total of 437 patients were enrolled: 294 in the bypass group and 143 in the endovascular therapy (EVT) group. After propensity score matching, 264 and 113 patients remained in the groups, respectively. A median occlusion length was 250 mm. One-year and two-year primary and secondary patency rates were comparable in both groups (two-year primary patency: 68.5% for bypass vs. 68.9% for EVT, p = 1.00). In the “above the knee” subgroup analysis, two-year secondary patency was higher in the EVT group than in the bypass group (90.9% vs. 77.5%, p = 0.048). In “below-the-knee” subgroup analysis, primary and primary assisted patency were statistically significantly higher in the EVT group than in artificial bypass subgroup (66.7% vs. 42.4%, p = .046 and 76.7% vs. 45.5%, p = .011, respectively). However, compared to autovenous bypass, the EVT group showed lower primary patency rates, although the differences are not significant.

Conclusion

A nonselective endovascular strategy can allow for regular successful treatment of femoro-popliteal lesions longer than 25 cm.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.
Fig. 2.
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Norgren L, Hiatt WR, Dormandy JA, et al. Inter-society consensus for the management of peripheral arterial disease (TASC II). Eur J Vasc Endovasc Surg. 2007;33(Suppl 1):S1–75. https://doi.org/10.1016/j.ejvs.2006.09.024.

    Article  PubMed  Google Scholar 

  2. Steering Committee TASC, Jaff MR, White CJ, et al. An update on methods for revascularization and expansion of the TASC lesion classification to include below-the-knee arteries: a supplement to the inter-society consensus for the management of peripheral arterial disease (TASC II). J Endovasc Ther. 2015;22(5):663–77. https://doi.org/10.1177/1526602815592206.

    Article  Google Scholar 

  3. Aboyans V, Ricco JB, Bartelink MEL, et al. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European society for vascular surgery (ESVS): document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesendorsed by: the European stroke organization (ESO)The Task Force for the diagnosis and treatment of peripheral arterial diseases of the European society of cardiology (ESC) and of the European society for vascular surgery (ESVS). Eur Heart J. 2018;39(9):763–816. https://doi.org/10.1093/eurheartj/ehx095.

    Article  PubMed  Google Scholar 

  4. Lin Y, Tang X, Fu W, Kovach R, George JC, Guo D. Stent fractures after superficial femoral artery stenting: risk factors and impact on patency. J Endovasc Ther. 2015;22(3):319–26. https://doi.org/10.1177/1526602815580783.

    Article  PubMed  Google Scholar 

  5. Duda SH, Bosiers M, Lammer J, et al. Drug-eluting and bare nitinol stents for the treatment of atherosclerotic lesions in the superficial femoral artery: long-term results from the SIROCCO trial. J Endovasc Ther. 2006;13(6):701–10. https://doi.org/10.1583/05-1704.1.

    Article  PubMed  Google Scholar 

  6. Laird JR, Katzen BT, Scheinert D, et al. Nitinol stent implantation versus balloon angioplasty for lesions in the superficial femoral and proximal popliteal arteries of patients with claudication: three-year follow-up from the RESILIENT randomized trial. J Endovasc Ther. 2012;19(1):1–9. https://doi.org/10.1583/11-3627.1.

    Article  PubMed  Google Scholar 

  7. Werner M, Paetzold A, Banning-Eichenseer U, et al. Treatment of complex atherosclerotic femoropopliteal artery disease with a self-expanding interwoven nitinol stent: midterm results from the Leipzig SUPERA 500 registry. EuroIntervention. 2014;10(7):861–8. https://doi.org/10.4244/EIJV10I7A147.

    Article  PubMed  Google Scholar 

  8. Garcia L, Jaff MR, Metzger C, et al. (2015) Wire-interwoven nitinol stent outcome in the superficial femoral and proximal popliteal arteries: twelve-month results of the SUPERB Trial [published correction appears in Circ Cardiovasc Interv. 2015 Jun;8(6). pii: e000014. doi: https://doi.org/10.1161/HCV.0000000000000014]. Circ Cardiovasc Interv, 8(5): e000937. doi:https://doi.org/10.1161/CIRCINTERVENTIONS.113.000937.

  9. Conte MS, Bradbury AW, Kolh P, et al. (2019) Global vascular guidelines on the management of chronic limb-threatening ischemia [published correction appears in Eur J Vasc Endovasc Surg. 2020 Mar;59(3):492–493] [published correction appears in Eur J Vasc Endovasc Surg, 60(1):158–159]. Eur J Vasc Endovasc Surg. 58(1S):S1-S109.e33. doi:https://doi.org/10.1016/j.ejvs.2019.05.006.

  10. Rassen JA, Schneeweiss S. Using high-dimensional propensity scores to automate confounding control in a distributed medical product safety surveillance system. Pharmacoepidemiol Drug Saf. 2012;21:41–9. https://doi.org/10.1002/pds.2328.

    Article  PubMed  Google Scholar 

  11. Ruzankin PS. A fast algorithm for maximal propensity score matching. Methodol Comput Appl Probab. 2019. https://doi.org/10.1007/s11009-019-09718-4.

    Article  Google Scholar 

  12. Aihara H, Soga Y, Mii S, et al. Comparison of long-term outcome after endovascular therapy versus bypass surgery in claudication patients with trans-atlantic inter-society consensus-II C and D femoropopliteal disease. Circ J. 2014;78(2):457–64. https://doi.org/10.1253/circj.cj-13-1147.

    Article  PubMed  Google Scholar 

  13. Lammer J, Zeller T, Hausegger KA, et al. (2015) Sustained benefit at 2 years for covered stents versus bare-metal stents in long SFA lesions: the VIASTAR trial [published correction appears in Cardiovasc Intervent Radiol. 38(3):779–80]. Cardiovasc Intervent Radiol, 38(1):25–32. doi:https://doi.org/10.1007/s00270-014-1024-9.

  14. Reijnen MMPJ, van Walraven LA, Fritschy WM, et al. 1-Year results of a multicenter randomized controlled trial comparing heparin-bonded endoluminal to femoropopliteal bypass. JACC Cardiovasc Interv. 2017;10(22):2320–31. https://doi.org/10.1016/j.jcin.2017.09.013.

    Article  PubMed  Google Scholar 

  15. Enzmann FK, Nierlich P, Aspalter M, et al. Nitinol stent versus bypass in long femoropopliteal lesions: 2-year results of a randomized controlled trial. JACC Cardiovasc Interv. 2019;12(24):2541–9. https://doi.org/10.1016/j.jcin.2019.09.006.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Vascular Pathology and Hybrid Technologies, Meshalkin National Medical Research Center of the Ministry of Healthcare of the Russian Federation, Novosibirsk Area, Rechkunovskaya 15’th st., Novosibirsk, Russia, 630055

    Alexander A. Gostev, Olesya S. Osipova, Shoraan B. Saaya, Savr V. Bugurov, Alexey V. Cheban, Artem A. Rabtsun, Pavel V. Ignatenko & Andrey A. Karpenko

Authors
  1. Alexander A. Gostev
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Olesya S. Osipova
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shoraan B. Saaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Savr V. Bugurov
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alexey V. Cheban
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Artem A. Rabtsun
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Pavel V. Ignatenko
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Andrey A. Karpenko
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexander A. Gostev.

Ethics declarations

Conflicts of interest

Authors do not have any potential conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gostev, A.A., Osipova, O.S., Saaya, S.B. et al. Bypass Versus Interwoven Nitinol Stents for Long Femoro-Popliteal Occlusions: A Propensity Matched Analysis. Cardiovasc Intervent Radiol 45, 929–938 (2022). https://doi.org/10.1007/s00270-022-03134-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-022-03134-x

Keywords

Search

Navigation