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  • Endovascular Therapy with Stents Shows Similar Results to Bypass Surgery in Symptomatic Femopopliteal PAD – Pooled Analysis

    Endovascular therapy (EVT) with stent implantation is a safe and efficient alternative to bypass surgery (BSx) in patients with symptomatic femoropopliteal peripheral artery disease (PAD), according to a new study.

    Serdar Farhan, MD, from Icahn School of Medicine at Mount Sinai, New York, and colleagues reported these findings in a manuscript published Monday online and in the Jan. 31 issue of the Journal of the American College of Cardiology.

    Previous randomized controlled trials comparing EVT with stent implantation vs. BSx found promising results for primary patency after EVT. However, no conclusions on clinical endpoints such as major adverse limb events (MALE) or amputation-free survival could be made because of the trials’ small sample sizes.

    Therefore, Farhan and colleagues performed a pooled analysis of individual patient data from randomized controlled trials comparing outcomes of patients with femoropopliteal PAD who underwent EVT with stent implantation vs BSx.

    Principal investigators of five of the six available randomized controlled trials agreed to pool individual patient-level data.

    A total of 639 patients were analyzed. They had a mean age of 68.1 ± 9.1 years, and 29.0% were women. Baseline characteristics were comparable between the groups.

    At 2 years, there were no significant differences between patients who received EVT and those who received BSx regarding MALE (40.1% vs 36.4%; log-rank P = 0.447; adjusted HR [aHR]: 1.04; 95% confidence interval [CI]: 0.80-1.36), amputation-free survival (88.1% vs 90.0%; log-rank P = 0.455; aHR for death or amputation: 1.04; 95% CI: 0.63-1.71) and the other secondary endpoints except for primary patency, which was lower in patients who received EVT than in those who received BSx (51.2% vs 61.3%; log-rank P = 0.024; aHR for loss of primary patency: 1.31; 95% CI: 1.02-1.69). EVT was associated with significantly lower rates of early complications (6.8% vs 22.6%; P < 0.001) and shorter hospital stay (3.1 +/- 4.2 days vs 7.4 +/- 4.9 days; P < 0.001).

    The mains findings showed that in patients with symptomatic PAD involving the femoropopliteal segment, EVT with stent implantation was associated with similar 2-year rates of major adverse limb events and amputation-free survival, but lower rates of early complications and shorter length of hospitalization, compared with BSx. This pooled analysis of individual patient-level data further supports the efficacy and safety of EVT with stent implantation as an alternative to BSx in this patient population, the authors concluded.

    An editorial comment on this paper was written by Marc P. Bonaca, MD, MPH, from CPC Clinical Research and the University of Colordo, both in Aurora, and Shea E. Hogan, MD, of CPC Clinical Research, the University of Colorado School of Medicine, and Denver Health Hospital. Bonaca and Hogan wrote that the authors should be congratulated for their analysis.

    The editorialists added that there is a continued unmet need for management options to help PAD patients. Given the ever-increasing complexity of these patients, there is a need for a multidisciplinary peripheral artery disease team approach.

    Finally, the commenters said it is also important for clinicians to work with patients when deciding on management strategies, including a revascularization approach for symptomatic PAD.


    Farhan S, Enzmann FK, Bjorkman P, et al. Revascularization Strategies for Patients With Femoropopliteal Peripheral Artery Disease. J Am Coll Cardiol 2023;81:358–370.

    Bonaca MP, Hogan SE. Tradeoffs in Approach to PAD Revascularization Shared Decision Making in the Spotlight. J Am Coll Cardiol 2023;81:371–373.

    Image Credit: AGPhotography –

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