How treatment decisions can impact young adults with PAD and advanced femoropopliteal disease
Bypass surgery is associated with a lower reintervention rate than endovascular therapy among patients with premature peripheral artery disease (PAD) and advanced femoropopliteal disease, according to new findings published in the Journal of Vascular Surgery. Overall, however, patient outcomes are comparable between the two treatment options.
The retrospective study included data from more than 2,500 patients who were treated from 2003 to 2019. Data came from the Society for Vascular Surgery’s Vascular Quality Initiative database, and all patients presented with PAD when they were 50 years old or younger.
While more than 1,600 patients underwent femoropopliteal bypass, another 902 patients underwent isolated femoropopliteal endovascular intervention. Propensity score matching was also used to compare 466 patients from each group.
Overall, the authors found, patients in the endovascular therapy group were more likely to present with diabetes, coronary artery disease, renal failure requiring dialysis and claudication.
When looking at the matched cohorts of 466 patients, 17% of patients in the femoropopliteal bypass group required reintervention compared to 25.2% of patients in the endovascular therapy group. However, the authors emphasized, patients who did require reintervention were more than three times as likely to require open surgical reintervention if they were in the femoropopliteal bypass group.
Also, femoropopliteal bypass was associated with a higher rate of perioperative morbidity than endovascular therapy (12% vs. 7.9%) and shorter lengths of stay (3 days vs. 6.4 days).
The major amputation rate was similar for both groups: 7.7% for the femoropopliteal bypass group and 7.9% for the endovascular therapy group. Mortality, meanwhile, was 5.2% for both groups
“Although the reintervention rate was greater among patients who had undergone endovascular intervention, the overall rates of reintervention and major amputation were high for both groups,” wrote lead author Tanner I. Kim, MD, of the division of vascular surgery at Yale University School of Medicine, and colleagues. “Even for those patients who had undergone bypass with a venous conduit, reinterventions were common and higher than for historical controls. The poor limb-related outcomes among the patients with premature PAD are well documented and have been significantly worse than those for older patients, although limited data are available regarding the comparative outcomes between the two revascularization strategies for patients with premature PAD.”
Kim et al. also noted that additional research, including a more thorough financial analysis, is still needed in this area.
“Economic studies accounting for the costs of increased perioperative morbidity and hospital stay and reinterventions are required to determine which strategy is most cost effective,” the authors concluded.
Read the full study here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.