RESULTS OF FEMOROPOPLITEAL BYPASS GRAFTING WITH EPOXY-TREATED VASCULAR XENOGRAFT AND STENTING IN ATHEROSCLEROSIS OF THE LOWER EXTREMITIES

Highlights

Autogenous arterial grafts are the most optimal choice of treatment in direct revascularization of the femoropopliteal segment of the lower extremity arteries. However, autogenous grafts can be unavailable due to a number of different clinical, anatomical and technical limitations. Biological prostheses are an alternative choice. They are extremely convenient for the surgeon, show high strength, flexibility, low thrombogenicity, sufficient biocompatibility, reduced susceptibility to infection, sufficient elasticity, and inertness to surrounding tissues. Another method of treating atherosclerosis is stenting. This technique is widespread, but it has its drawbacks. According to literary data, this technique does not always show satisfactory results of primary and secondary patency. The study and comparison of these techniques remains relevant. In this article, we compared the results of femoropopliteal bypass and stenting for occlusive lesion of the femoropopliteal segment of the lower extremity arteries.

Abstract

Aim. To conduct a comparative retrospective analysis of the immediate and mid-term results of femoropopliteal bypass grafting with the “KemAngioprotez” epoxy-treated vascular xenograft and stenting for atherosclerosis of the lower extremity arteries.

Methods. Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases” and the State Autonomous Healthcare Institution “Korolev Clinical Hospital named after S.V. Belyaev” provided the data for the analysis. The study included 115 patients who underwent femoropopliteal bypass with the “KemAngioprotez” epoxy-treated vascular xenograft from 2012 to 2022 and 73 patients who underwent stenting from 2014 to 2023 for chronic occlusive lesion of the lower extremity arteries. Data analysis was performed using the StatTech v. 4.6.3 software (Stattech LLC, Russia).

Results. The analysis of the patients from the subgroup with a 1-6-month follow-up revealed statistically significant differences regarding primary patency - 84.4% in the bypass group, 62.5% in the stenting group (p = 0.002), repeat unplanned intervention on the target limb - 10.1% in the bypass group, 34.7% in the stenting group (p < 0.001), the number of aneurysms - 0.0% in the bypass group, 8.3% in the stenting group (p = 0.008), and the number of amputations - 0.9% in the bypass group, 14.3% in the stenting group (p = 0.001).

During 7-12-month follow-up there were no statistically significant differences between the groups in terms of end points. When analyzing the two-year results, the bypass group demonstrated advantages over the stenting group in terms of primary patency (79.6% vs. 45.5%, respectively, (p = 0.002)), repeat unplanned intervention (4.2% vs. 45.5%, respectively, (p < 0.001)). The groups did not show significant differences in the number of amputations and aneurysm formation.

Conclusion. According to the results obtained, when choosing a treatment strategy between a stenting procedure with unmodified stents and a femoropopliteal bypass, in the absence of a pronounced comorbidities, specialists should choose the open revascularization. Considering the data obtained in a continuous sample of patients, the clinical effectiveness of endovascular interventions is still debatable, but it still has its place in clinical practice.

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