Objective: The aim of the study was to compare the early and medium-term outcomes of bypass vs endovascular treatment of occluded femoro-popliteal stents in patients with chronic limb-threatening ischemia (the OUT-STEPP 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, acute kidney injury, 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 <.001). The mean length of intensive care unit stay and the mean hospital stay were higher for patients in Group OPEN ([0.3 ± 0.9 vs 0 days; P <.001] and [9.7 ± 5.8 vs 3.3 ± 1.4 days; P <.001], respectively). The overall median duration of follow-up was 33.1 months (interquartile range, 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 =.27; log-rank, 1.21), primary patency (56.3% Group OPEN vs 67.8% Group ENDO; P =.39; log-rank, 0.75), secondary patency (59.1% Group OPEN vs 77.8% Group ENDO; P =.24; log-rank, 1.40), absence of target lesion restenosis (56.8% Group OPEN vs 62.7% Group ENDO; P =.42; log-rank, 0.65), and limb salvage (77.2% Group OPEN vs 90.4% Group ENDO; P =.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 patients with chronic limb-threatening ischemia. Open surgery was associated with longer stay in hospital and increased use of blood transfusions. At 5 years, no significant differences were found in the rates of overall patency or limb salvage between bypass and endovascular treatment.

Bypass vs endovascular treatment for occluded femoro-popliteal stents in patients with critical limb-threatening ischemia / D'Oria, M.; Berchiolli, R.; Gargiulo, M.; Antonello, M.; Pratesi, G.; Michelagnoli, S.; Silingardi, R.; Isernia, G.; Veraldi, G. F.; Tinelli, G.; Giudice, R.; Ippoliti, A.; Cappiello, P.; Martelli, M.; Lepidi, S.; Troisi, N.; Abualhin, M.; Andreini, M.; Bastianon, M.; Calvagna, C.; Colacchio, C.; D'Andrea, A.; Esposito, A.; Caneva, P. D.; Fazzini, S.; Ferrer, C.; Gallitto, E.; Gennai, S.; Giordano, A. N.; Leone, N.; Mastrorilli, D.; Melani, C.; Mena Vera, J. M.; Mezzetto, L.; Parlani, G.; Scarati, V.; Sica, S.; Simonte, G.; Squizzato, F.; Spath, P.; Thsomba, Y.; Visciglia, E.; Zanetti, E.. - In: JOURNAL OF VASCULAR SURGERY. - ISSN 0741-5214. - 78:5(2023), pp. 1270-1277. [10.1016/j.jvs.2023.07.053]

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

Silingardi R.;Gennai S.;
2023

Abstract

Objective: The aim of the study was to compare the early and medium-term outcomes of bypass vs endovascular treatment of occluded femoro-popliteal stents in patients with chronic limb-threatening ischemia (the OUT-STEPP 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, acute kidney injury, 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 <.001). The mean length of intensive care unit stay and the mean hospital stay were higher for patients in Group OPEN ([0.3 ± 0.9 vs 0 days; P <.001] and [9.7 ± 5.8 vs 3.3 ± 1.4 days; P <.001], respectively). The overall median duration of follow-up was 33.1 months (interquartile range, 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 =.27; log-rank, 1.21), primary patency (56.3% Group OPEN vs 67.8% Group ENDO; P =.39; log-rank, 0.75), secondary patency (59.1% Group OPEN vs 77.8% Group ENDO; P =.24; log-rank, 1.40), absence of target lesion restenosis (56.8% Group OPEN vs 62.7% Group ENDO; P =.42; log-rank, 0.65), and limb salvage (77.2% Group OPEN vs 90.4% Group ENDO; P =.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 patients with chronic limb-threatening ischemia. Open surgery was associated with longer stay in hospital and increased use of blood transfusions. At 5 years, no significant differences were found in the rates of overall patency or limb salvage between bypass and endovascular treatment.
2023
78
5
1270
1277
Bypass vs endovascular treatment for occluded femoro-popliteal stents in patients with critical limb-threatening ischemia / D'Oria, M.; Berchiolli, R.; Gargiulo, M.; Antonello, M.; Pratesi, G.; Michelagnoli, S.; Silingardi, R.; Isernia, G.; Veraldi, G. F.; Tinelli, G.; Giudice, R.; Ippoliti, A.; Cappiello, P.; Martelli, M.; Lepidi, S.; Troisi, N.; Abualhin, M.; Andreini, M.; Bastianon, M.; Calvagna, C.; Colacchio, C.; D'Andrea, A.; Esposito, A.; Caneva, P. D.; Fazzini, S.; Ferrer, C.; Gallitto, E.; Gennai, S.; Giordano, A. N.; Leone, N.; Mastrorilli, D.; Melani, C.; Mena Vera, J. M.; Mezzetto, L.; Parlani, G.; Scarati, V.; Sica, S.; Simonte, G.; Squizzato, F.; Spath, P.; Thsomba, Y.; Visciglia, E.; Zanetti, E.. - In: JOURNAL OF VASCULAR SURGERY. - ISSN 0741-5214. - 78:5(2023), pp. 1270-1277. [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, G. F.; Tinelli, G.; Giudice, R.; Ippoliti, A.; Cappiello, P.; Martelli, M.; Lepidi, S.; Troisi, N.; Abualhin, M.; Andreini, M.; Bastianon, M.; Calvagna, C.; Colacchio, C.; D'Andrea, A.; Esposito, A.; Caneva, P. D.; Fazzini, S.; Ferrer, C.; Gallitto, E.; Gennai, S.; Giordano, A. N.; Leone, N.; Mastrorilli, D.; Melani, C.; Mena Vera, J. M.; Mezzetto, L.; Parlani, G.; Scarati, V.; Sica, S.; Simonte, G.; Squizzato, F.; Spath, P.; Thsomba, Y.; Visciglia, E.; Zanetti, E.
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