The treatment of complex femoropopliteal atherosclerotic lesions- conclusions from the unselected patients cohort.

Introduction: Endovascular techniques have revolutionized the treatment of lower extremity artery disease (LEAD). Despite this, the treatment of complex femoropopliteal lesions is a field of debate. This report sum marizes the current experience in the treatment of complex femoropopliteal lesions in the author’s center. Material and methods: This is a retrospective, observational cohort study of patients with complex (TASC C and D) femoropopliteal lesions. The patients were treated using either endovascular procedure or surgical bypass. Details of the procedure, complications, mortality and amputation rate, primary and secondary patency rates, and reinterventions were analyzed. Results: The study included 201 patients. One hundred thirty patients received endovascular treatment (ET), whereas in 67 a femoropopliteal bypass (FB) was implanted. The hybrid approach was utilized in 4 patients. ET was preferred in primary (88.5% vs. 47.8%, p < 0.001), shorter (25 vs. 30 cm, p < 0.02), TASC C lesions (63.1% vs. 40.3%, p < 0.003). Complications were more common in FB group (26.9% vs. 13.8%, p < 0.03). Reinterventions were similar. The postoperative stay was shorter in the ET group (1 vs. 6 days, p < 0.001). Primary and secondary patency rates for autologous vein reconstruction were insignificantly higher than for ET. Primary and secondary patency in patients with synthetic bypass was significantly inferior to autologous vein conduit (AVC) and endovascular procedure. The limb salvage at 3 years was highest in the ET group (94.1%) and the difference was significant (p < 0.04, and p < 0.001 for AVC and synthetic bypass, respectively). Conclusions: ET is preferred in primary and shorter lesions and is related to the shorter postoperative stay. It carries a lower risk of major amputation than surgery. Autologous vein conduit provides highest primary and secondary patency rates. Both treatment options (surgery and endovascular) should be considered in patients with long femoropopliteal lesions to assure the optimal outcome.