The following is a summary of “Revascularization Strategies for Patients With Femoropopliteal Peripheral Artery Disease,” published in the 2023 January issue of Cardiology by Farhan, et al.

There were no studies with sufficient sample sizes to evaluate significant clinical outcomes between bypass surgery (BSx) and endovascular therapy (EVT) for symptomatic femoropopliteal peripheral artery disease. Therefore, to compare EVT with BSx, all randomized controlled trials’ individual patient data were combined by researchers for the study’s analysis.

Five of the 6 randomized controlled studies that were accessible consented to pool their individual patient data. Major adverse limb events—a composite of all-cause mortality, major amputation, or target limb reintervention—were the main objective. Amputation-free survival, specific significant adverse limb event components, and main patency were considered secondary goals. Early problems included bleeding, infection, or death from any cause in under 30 days.

A total of 639 patients were examined; their average age was 68.1±9.1 years, and 29.0% were women. Between groups, baseline traits were comparable. At 2 years, there were no significant differences between patients who received EVT and those who received BSx in terms of major adverse limb events (40.1% vs. 36.4%; log-rank P = 0.447; adjusted HR [aHR]: 1.04; 95% 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 vs. 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). Early problems were much rare with EVT(6.8% vs 22.6%; P < 0.001) and hospital stays were shorter (3.1 ± 4.2 days vs 7.4 ± 4.9 days; P < 0.001).

The effectiveness and safety of EVT as an alternative to BSx in individuals with symptomatic femoropopliteal peripheral artery disease were further supported by these data.

Reference: jacc.org/doi/10.1016/j.jacc.2022.10.036