Surgical Bypass Strongly Beats Endovascular Treatment as Preferred Treatment of Blocked Blood Vessels in the Femoral Artery
November 23, 2011 – Vascular occlusions are blocked blood vessels caused by a blood clot in an artery. Blocks in the femoral artery are particularly problematic, and vascular surgeons continue to research and debate on the best methods to treat these clots. Results from the THRUPASS Study Group’s randomized controlled trial comparing superficial femoral artery (SFA) lesion treatment with either endoluminal polytetrafluoroethylene (PTFE) thrupass (Viabahn) or with surgical PTFE bypass were presented to attendees at the 38th Annual VEITH symposium in New York City by Mauri J.A. Lepantalo, M.D., Helsinki University Central Hospital, Helsinki, Finland.
In the study, the SFA lesions of the patients were 5-25 cm occlusions, with a mean length of 11.4 cm. The patients were followed for three years by physical exam, duplex ultrasound or other imaging modalities. The endpoint of greatest interest was primary patency, followed by secondary patency, functional success, costs and quality of life. Lepantalo said, “The goal had been to enroll 60 patients in each arm. However, the trial was prematurely terminated due to results at the interim analysis, when only 44 patients had been enrolled. There was a significant patency difference in favor of surgical bypass over endovascular thrupass (95 percent versus 44 percent).”
Lepantalo noted that this was a difficult trial to enroll patients, because the investigators were looking carefully for comparable lesions to which to randomize treatment. “The real problem with comparing different modes of treatment for lower limb ischemia is in controlling for the disease, to ensure that the comparisons are among patients with the same lesions. This is compounded by the fact that different physicians interpreting the same lesions will characterize them differently,” said Lepantalo.
In this study, the results showed that treatment of superficial femoral artery occlusions should be done by PTFE bypass rather than by PTFE thrupass, as the later method leads to a worse early outcome.
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