Stents no better than surgery in long leg lesions in PAD

Salzburg, Austria: Nitinol stents as compared to primary vein bypass doesn't fare well for certain outcomes in patients with long femoropopliteal lesions (long leg lesions), suggests a recent study published in the JACC: Cardiovascular Interventions journal. Nitinol stents are widely used as standard endovascular therapy.

According to the study, there were no significant differences in complications, survival, patency rates, and limb salvage after 2 years. Clinical improvement and technical success were significantly better in the bypass group. But the promising results of the stent group suggest than an endovascular-first strategy for femoropopliteal lesions up to 30 cm may be reasonable.

For the treatment of long femoropopliteal lesions, an endovascular-first strategy is widely recommended without sufficient data comparing it with bypass surgery. Florian K. Enzmann, Paracelsus Medical University, Salzburg, Austria, and colleagues performed a single-center randomized controlled trial to compare patency rates and clinical outcomes of nitinol stents and primary vein bypass in long femoropopliteal lesions.

The study involved 103 participants with 110 affected limbs, roughly half with claudication and the rest with critical limb ischemia. Patients were eligible if they had TASC II type C (60%) or D lesions (40%).

Primary endpoints were technical success, primary and secondary patency. Secondary endpoints were limb salvage, survival, complications, and clinical improvement.

Also Read: Bioresorbable Stents for Peripheral Vessels – Dr NN Khanna

Key findings of the study include:

• Baseline and lesion characteristics were similar, with a mean lesion length of 276 mm.


• Critical limb-threatening ischemia was the indication for treatment in 49% of limbs in both groups.


• Technical success was achieved in 87% in the stent group.


• During a 2-year follow-up, patency rates, limb salvage, survival, and complications showed no significant differences between both groups.


• At 24 months, primary and secondary patency rates for the stent group were 60% and 72% versus 56% and 73% in the bypass group, respectively.


• Clinical improvement was significantly better in the bypass group.

"The promising results of the stent group suggest that an endovascular-first strategy for femoropopliteal lesions up to 30 cm may be reasonable. Mid- as well as long-term results, need to be awaited," concluded the authors.

The study, "Nitinol Stent Versus Bypass in Long Femoropopliteal Lesions: 2-Year Results of a Randomized Controlled Trial," is published in the JACC: Cardiovascular Interventions journal.

DOI: 10.1016/j.jcin.2019.09.006