Bypass versus endovascular revascularization for patients with atherosclerotic occlusive disease of the superficial femoral artery

<b></b> <i>Background:</i> Atherectomy emerged recently as an interventional modality for vessel preparation with high rates of mid-term primary patency. However, data regarding the comparison of rotational atherectomy for long calcified lesions with bypass surgery above-the-knee are lacking. Aim to investigate early and mid-term outcomes of this endovascular treatment compared to bypass surgery. <i>Patients and methods:</i> In this retrospective analysis, patients with de novo occlusive TASC D lesions of the superficial femoral artery (SFA) were included. A synthetic above-knee femoropopliteal bypass was preferred as the initial treatment approach for patients with absence of a patent origin/stump of the SFA (group A). On the other hand, in case of patent stump of the SFA of at least 1 cm or more, an endovascular approach with rotational atherectomy and DCB angioplasty with bail-out stenting was preferred (group B). <i>Results:</i> Thirty-eight patients formed group A, and thirty-nine group B. Technical success/stent free technical success was met in 37/38 patients in group A and in 29/39 patients in group B respectively (p<.001). Primary patency was 89.5% in group A compared to 94.7% in group B (log rank test: p=.468), while the secondary patency was 94.9% versus 94.7% (log rank test: p=.068). In group B, two patients required re-intervention 24 months after the initial procedure. In group A, two patients suffered from bypass occlusion occurring 8 months after the initial procedure and unterwent a re-intervention. <i>Conclusions:</i> Endovascular atherectomy-assisted revascularisation and prosthetic bypass exhibit good patency. The time of occurrence of re-interventions differ between the 2 groups unterlining the need for meticulous follow up.