Objectives: the aim of the study was to compare the early and medium-term outcomes of bypass versus endovascular treatment of occluded femoro-popliteal stents in patients with chronic limb-threatening ischemia (CLTI) (the OUT-STEPP2 multicentric registry). Methods: between January 2016 and December 2021 317 patients in 14 centers underwent treatment for a symptomatic occlusion of femoro-popliteal stent/stents. One-hundred-sixty-one patients were included into the present study: 46 (28.6%) underwent open bypass surgery (Group OPEN), and 115 (71.4%) underwent endovascular revascularization (Group ENDO). Early (30 days) results were assessed and compared between the two groups. Estimated 5-year outcomes were evaluated and compared with the log-rank test. Results: at 30 days no differences were found in terms of Major Adverse Cardiovascular Events (MACE), Acute Kidney Injury (AKI), reinterventions, major amputation, and all-cause mortality between the two groups. The need for blood transfusions was higher for patients in Group OPEN (17, 36.9% vs. 13, 11.3%; p<0.001). The mean length of Intensive Care Unit (ICU) stay and the mean hospital stay were higher for patients in Group OPEN [(0.3 ± 0.9 vs. 0; p<0.001) and (9.7 ± 5.8 vs. 3.3 ± 1.4 days; p<0.001), respectively]. The overall median duration of follow-up was 33.1 (IQR 14-49.5) months. At 5 years there were no differences between the two groups in terms of survival (68.7% Group OPEN vs. 68.8% Group ENDO; p=0.27, log-rank 1.21), primary patency (56.3% Group OPEN vs. 67.8% Group ENDO; p=0.39, log-rank 0.75), secondary patency (59.1% Group OPEN vs. 77.8% Group ENDO; p=0.24, log-rank 1.40), absence of target lesion restenosis (56.8% Group OPEN vs. 62.7% Group ENDO; p=0.42, log-rank 0.65), and limb salvage (77.2% Group OPEN vs. 90.4% Group ENDO; p=0.17, log-rank 1.87). Conclusions: both bypass and endovascular treatment provided safe and effective restoration of patency for femoro-popliteal in-stent occlusion in CLTI patients. Open surgery was associated with longer stay in hospital and increased use of blood transfusions. At five-years, no significant differences were found in the rates of overall patency or limb salvage between bypass and endovascular treatment.

D'Oria, M., Berchiolli, R., Gargiulo, M., Antonello, M., Pratesi, G., Michelagnoli, S., et al. (2023). Bypass versus endovascular treatment for occluded femoro-popliteal stents in patients with critical limb-threatening ischemia. JOURNAL OF VASCULAR SURGERY, 31, 1-8 [10.1016/j.jvs.2023.07.053].

Bypass versus endovascular treatment for occluded femoro-popliteal stents in patients with critical limb-threatening ischemia

Pratesi, Giovanni;Ippoliti, Arnaldo;
2023-07-31

Abstract

Objectives: the aim of the study was to compare the early and medium-term outcomes of bypass versus endovascular treatment of occluded femoro-popliteal stents in patients with chronic limb-threatening ischemia (CLTI) (the OUT-STEPP2 multicentric registry). Methods: between January 2016 and December 2021 317 patients in 14 centers underwent treatment for a symptomatic occlusion of femoro-popliteal stent/stents. One-hundred-sixty-one patients were included into the present study: 46 (28.6%) underwent open bypass surgery (Group OPEN), and 115 (71.4%) underwent endovascular revascularization (Group ENDO). Early (30 days) results were assessed and compared between the two groups. Estimated 5-year outcomes were evaluated and compared with the log-rank test. Results: at 30 days no differences were found in terms of Major Adverse Cardiovascular Events (MACE), Acute Kidney Injury (AKI), reinterventions, major amputation, and all-cause mortality between the two groups. The need for blood transfusions was higher for patients in Group OPEN (17, 36.9% vs. 13, 11.3%; p<0.001). The mean length of Intensive Care Unit (ICU) stay and the mean hospital stay were higher for patients in Group OPEN [(0.3 ± 0.9 vs. 0; p<0.001) and (9.7 ± 5.8 vs. 3.3 ± 1.4 days; p<0.001), respectively]. The overall median duration of follow-up was 33.1 (IQR 14-49.5) months. At 5 years there were no differences between the two groups in terms of survival (68.7% Group OPEN vs. 68.8% Group ENDO; p=0.27, log-rank 1.21), primary patency (56.3% Group OPEN vs. 67.8% Group ENDO; p=0.39, log-rank 0.75), secondary patency (59.1% Group OPEN vs. 77.8% Group ENDO; p=0.24, log-rank 1.40), absence of target lesion restenosis (56.8% Group OPEN vs. 62.7% Group ENDO; p=0.42, log-rank 0.65), and limb salvage (77.2% Group OPEN vs. 90.4% Group ENDO; p=0.17, log-rank 1.87). Conclusions: both bypass and endovascular treatment provided safe and effective restoration of patency for femoro-popliteal in-stent occlusion in CLTI patients. Open surgery was associated with longer stay in hospital and increased use of blood transfusions. At five-years, no significant differences were found in the rates of overall patency or limb salvage between bypass and endovascular treatment.
31-lug-2023
Online ahead of print
Rilevanza internazionale
Articolo
Esperti anonimi
Settore MED/22
English
femoro-popliteal artery
multicenter
peripheral arterial disease
stent
thrombosis
D'Oria, M., Berchiolli, R., Gargiulo, M., Antonello, M., Pratesi, G., Michelagnoli, S., et al. (2023). Bypass versus endovascular treatment for occluded femoro-popliteal stents in patients with critical limb-threatening ischemia. JOURNAL OF VASCULAR SURGERY, 31, 1-8 [10.1016/j.jvs.2023.07.053].
D'Oria, M; Berchiolli, R; Gargiulo, M; Antonello, M; Pratesi, G; Michelagnoli, S; Silingardi, R; Isernia, G; Veraldi, Gf; Tinelli, G; Giudice, R; Ippo...espandi
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/335965
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