Background
We previously demonstrated that everolimus drug-eluting stents (eDES) have reasonable
short-term patency for the treatment of infrainguinal bypass stenoses. The aim of
this study is to compare mid-term outcomes of eDES, plain balloon angioplasty (PTA),
percutaneous cutting balloon (PCB), and drug-coated balloon (DCB) interventions for
failing infrainguinal bypasses.
Methods
We conducted a retrospective review of patients with infrainguinal bypass stenoses
treated by endovascular intervention (August 2010–August 2021). The primary outcome
was primary patency (PP). Secondary outcomes were primary-assisted patency (PAP),
secondary patency (SP), limb salvage (LS), and mortality. Outcomes were compared by
treatment using Kaplan-Meier curves with log-rank tests and Cox proportional hazards
models adjusting for baseline differences between groups.
Results
Seventy-two consecutive patients with 152 discrete infrainguinal bypass graft stenoses
were identified. Mean age was 65.1 ± 10.6 years, 55.6% were male, and 48.6% were Black.
In total, 81.9% of patients were originally treated for chronic limb-threatening ischemia,
and 57.2% of distal anastomoses were to tibial or pedal targets. Of 152 lesions, 44.1%
(n = 67) were treated with PTA, 17.8% (n = 27) with PCB, 20.4% (n = 31) with DCB, and 17.8% (n = 27) with eDES. Median follow-up was 28.5 months (interquartile range 11.5–51.9).
There was no difference in bypass configuration, conduit choice, or stenosis location
(proximal anastomosis, mid-bypass, distal anastomosis) between groups. At 24 months
postintervention, PP was significantly better for eDES (72.9%, 95% confidence interval
[CI] 49.8–85.6), followed by PCB (55.9%, 95% CI 34.2–72.9), PTA (34.4%, 95% CI 21.7–47.4),
and DCB (33.6%, 95% CI 14.5–53.9) (P = 0.03). PAP, LS, and mortality did not significantly differ between modalities (P > 0.05). After risk adjustment, eDES was associated with the lowest risk of PP loss
(hazard ratio versus PTA 0.15, 95% CI 0.05–0.47).
Conclusions
eDES is associated with superior 24-month patency rates compared to other endovascular
technologies, and should be considered a primary therapy modality for the treatment
of infrainguinal bypass graft stenoses.
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Article Info
Publication History
Published online: July 08, 2022
Accepted:
June 23,
2022
Received:
April 26,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Presented at the 2022 Annual Winter Meeting of the Vascular and Endovascular Surgery Society, Aspen, CO, January 2022; Podium Presentation.
Funding: No specific funding was utilized for this work. Dr. Hicks is supported by a grant from the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases (K23DK124515).
Disclosures: The authors have no relevant conflicts of interest to disclose.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
