Treatment of TASC C and D Symptomatic Superficial Femoral Artery Occlusive Disaese: Stent versus Above Knee Popliteal PTFE Bypass

Objectives: With an increasing availability of percutaneous means to revascularize the lower extremity, the ideal approach to treat severe symptomatic lesions of the superficial femoral artery(SFA) has yet to be identified. In the present study we compared stent or angioplasty to bypass to the above knee popliteal artery(AKP) for symptomatic TASC C and D SFA lesions .
Methods: A retrospective study was performed to identify those patients treated for symptomatic TASC C and D SFA occlusive disease. Patients were treated percutaneously by subintimal angioplasty and routine stenting (Group I) or with open surgical revascularization to the AKP with PTFE(Group II). Patient demographics, indications, mortality, morbidity were compared using Chi Square analysis. Patency in both groups was assessed using pulse volume recordings. In addition, patency and salvage were determined by life table methods and compared with log rank analysis.
Results: Between 2003 and 2007, 556 patients were treated for symptomatic SFA TASC C and D occlusive disease; 282(51%) underwent AKP PTFE bypass, and 27 (49%) underwent percutaneous subintimal angioplasty and stenting (Table 1). Twenty-five (9%) Group I stent patients required secondary procedures; 10 (4%) underwent angioplasty/ stent for instent stenosis, 25 (9%) underwent fem-distal bypass.Group II patients had increased mortality and morbidity when compared to Group I, ( 4%, 12% vs 0.4%, 1% ), p<0.05).
Conclusions: SFA subintimal angioplasty with routine stenting for treatment of symptomatic TASC C and D lesions has superior patency with less morbidity when compared to AKP PTFE bypass. Stent failure does not preclude additional open bypass procedures and might be considered the primary treatment of symptomatic SFA occlusive disease.