Acute limb ischemia after occluded femoro-popliteal stents: a comparative analysis between endovascular revascularization vs. open bypass (FOCUS Study).
Giulia Bertagna, Nicola Troisi, Mario D'Oria, Mauro Gargiulo, Michele Antonello, Giovanni Pratesi, Stefano Michelagnoli, Roberto Silingardi, Giacomo Isernia, Gian Franco Veraldi, Giovanni Tinelli, Rocco Giudice, Arnaldo Ippoliti, Pierluigi Cappiello, Massimiliano Martelli, Sandro Lepidi, Raffaella Berchiolli
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引用次数: 0
Abstract
Background: The aim of the study was to compare the early and medium-term outcomes of endovascular revascularization versus bypass for the treatment of occluded femoro-popliteal stents in patients with acute limb ischemia (ALI) (insights of the OUT-STEPP multicentric registry).
Methods: Between January 2016 and December 2021, 317 patients in 14 centers underwent treatment for symptomatic femoro-popliteal In-Stent Occlusion (ISO). Sixty patients with ALI were included into the present study: 42 (70%) underwent endovascular revascularization (Group ENDO), and 18 (30%) underwent open bypass surgery (Group OPEN). 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 (MACEs), acute kidney injury, reintervention(s), major amputation, and all-cause mortality between the two groups. The need for blood transfusions was similar in both groups (Group OPEN 7, 38.9% vs. Group ENDO 13, 30.1%; P=0.14). The mean length of hospital stay was higher for patients in Group OPEN (11.3±6.5 vs. 4.4±1.9 days; P<0.001). The overall median duration of follow-up was 35 (IQR 13-55.75) months. At 5 years there were no differences between the two groups in terms of survival (69.8% Group OPEN vs. 64.6% Group ENDO; P=0.76, log-rank 0.09), overall patency (71.4% Group OPEN vs. 72.8% Group ENDO; P=0.56, log-rank 0.34), freedom from reintervention(s) (76% Group OPEN vs. 63.4% Group ENDO; P=0.32, log-rank 0.99), and amputation-free survival (88.1% Group OPEN vs. 83.4% Group ENDO; P=0.76, log-rank 0.09).
Conclusions: Endovascular revascularization and bypass seem to provide effective flow restoration in patients with ALI due to femoro-popliteal ISO. Open surgery was associated with longer hospital stay. At 5 years, no significant differences were found between the two groups in terms of overall patency, need for reintervention(s), and amputation-free survival, even though further studies on a larger sample size and potentially prospective will be necessary to validate these preliminary findings.
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).
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