Medium Term Outcomes of Bypass Surgery for Recurrent Superficial Femoral Artery Lesions After Endovascular Treatment

Objective The study was performed to examine clinical outcomes of bypass surgery for recurrent superficial femoral artery (SFA) occlusive lesions after endovascular treatment (EVT). Method Patients who underwent bypass surgery for a recurrent SFA lesion after EVT at 4 Japanese vascular centers from 2015 to 2020 were analyzed retrospectively. The primary endpoint was graft patency (primary, assisted primary, and secondary). Results A total of 46 patients were included in the study. The patients had high rates of hypertension (85%), diabetes (70%), and chronic kidney disease (63%). Clinical presentation before EVT was intermittent claudication in 16 cases (35%) and chronic limb-threatening ischemia in 30 cases (65%). Initial EVT was performed for complex SFA lesions (lesion length, 200 125-260 mm; reference vessel diameter, 5.3 4.7-6.0 mm; chronic total occlusion, 50%; poor below-the-knee runoff vessel, 60%). The final device was a bare-nitinol stent in 26 cases (56%), stent graft in 9 (20%), and drug-eluting stent in 7 (15%). A total of 46 surgical reconstructions (above-the-knee femoropopliteal bypass, 15 (33%); below-the-knee femoropopliteal bypass, 7 (15%); tibial bypass, 24 (52%)) were performed using autologous vein grafts (72%) and prosthesis grafts (28%) in a median period of 300 145-556 days from initial EVT. The median procedure time was 201 159-299 min. No case had early graft occlusion or hospital death within 30 days. The median follow-up period was 27 (12.7-49.2) months. The 3-year primary, assisted primary, and secondary graft patencies were 57%, 70%, and 77%, respectively; the 3-year limb salvage was 84%; and the 3-year survival was 66%. Conclusion Medium term outcomes were acceptable in patients with bypass surgery for a recurrent SFA lesion after EVT.